Effective January 1, 2015, a service area reduction occurred for the Blue Cross Blue Shield of North Carolina (BCBSNC) Senior Market. Blue Medicare HMO Standard and Blue Medicare HMO Enhanced plans are no longer available in 11 counties and affected Covered Persons were required to choose a new plan for 2015. As a result of this change, Prime has received an increased volume of rejections for these Covered Persons.

Express Scripts began administering the pharmacy benefit for Priority Health members on Jan. 1, 2015. Please review the important BIN/PCN/Group Number information in the table below, which includes all possible combinations for Priority Health members.  They have also added coordination of benefits (COB)-specific PCNs for your convenience.

Claims Submission Information

While the following table is provided as a reference, please request the member’s ID card to obtain accurate processing information.

Prime Therapeutics, LLC has contracted with CoverMyMeds® to provide an electronic prior authorization (ePA) solution that allows Participating Pharmacies and Prescribing Providers the ability to submit PA requests within workflow. This online solution allows Participating Pharmacies and Prescribing Providers prescribers to receive real-time notifications of the PA outcome.

UnitedHealthcare Community Plan is administering prescription benefits for a number of new members and OptumRx will be processing the claims for them. Please help us ensure these members receive their prescriptions on the first day their enrollment is effective with us.