Effective January 1, 2016, Magellan Rx Medicare will assume administrative operation of the Pharmacy Benefit Management (PBM) program for AlphaCare. At that time, pharmacies must submit claims for payment through the Magellan Rx PBM system.

Effective January 1, 2016, Magellan Rx Medicare will be launching a new Medicare Part D Plan, Magellan Rx Medicare Basic (PDP). At that time, pharmacies must submit claims for payment through the Magellan Rx PBM system.

  This is a reminder of the upcoming mandate for ICD-10 data submission.   Diagnosis codes are not required for current processing, however beginning October 1, 2015, if diagnosis codes are submitted on the claim request, the only code values that should be supplied are ICD-10 values. Up to five (5) diagnosis codes may be submitted on the claim request using the Clinical Segment.  Per the NCPDP standard, when submitted, ICD-10 diagnosis codes should not contain a decimal point.    Please contact your pharmacy management software vendor for instruction on how to properly enter and submit ICD-10 codes in your software application.

On April 16, 2015 the Medicare Access and CHIP Authorization Act of 2015 (MACRA) was signed into law. Section 507 of MACRA amends Section 1860D-4(c) of the Social Security Act by requiring that pharmacy claims for covered Part D drugs include an active and valid Type 1 National Provider Identifier (NPI). Beginning January 1, 2016 a Part D sponsor cannot pay a claim that does not include an active and valid prescriber NPI.

OptumRx will manage claims processing for members of UA Local No. 7. Please note:  All members of UA Local No. 7 will receive a new member identification (ID) card as shown below.  Please process prescriptions online using the UA Local No. 7 ID card information.