Starting December 1, 2015, Medical Mutual of Ohio (MMO) implemented electronic COB for its commercial lines of business, except for groups in MMO’s Carrier Pre-Processing Plans. During processing of an MMO commercial claim, if the pharmacist submits an Other Coverage Code (OCC) in NCPDP Field 308-C8 with values = 2 through 4 or 8, the COB segment and all required fields must be sent

Effective 1/1/16, Trillium Community Health Plan will be making some changes. Catamaran, an OptumRx Company, is currently the Third Party Administrator for all Medicare Part D business. Medicare Part D members will be issued new ID cards along with new ID numbers (see example included). Please reference the appropriate section with BIN/PCN/ and ID numbers that are needed for processing. As always, ask the member for their new Member ID card to ensure you receive the proper processing information.

OptumRx will assume responsibility for claims processing for members of Avnet, Inc. Please Note:  All plan participants of Avent, Inc. will receive a new member identification (ID) card. Please refer to the sample of the new ID card below.  Prescriptions need to be processed on-line using the Avnet, Inc. ID card information.

The Hernandez Settlement guidelines apply to Medicaid Enrollees in the State of Florida, in which a few CVS/caremark clients are Medicaid HMO providers. The Florida Agency for Healthcare Administration (AHCA) requires that all participating pharmacy locations be in compliance with the Hernandez Settlement Agreement (HSA). An HSA non-compliance situation arises when a Medicaid HMO Enrollee is unable to get his or her prescription filled due to: • an unreasonable delay in filling the prescription • a denial of the prescription • the reduction of a prescribed good or service; and/or • the termination of a prescription

Effective January 1, 2016, CVS/caremark will begin to administer the prescription benefits for Quorum Health Corporation. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS/caremark. RXBIN: 004336 RXPCN: ADV RXGRP: RX0153 Member ID Format: 9 digits Person Code : 2 digits