Effective January 1, 2015, Prime West Medicaid and BCBS MN Medicaid will be implementing new policies for management of Opiate-containing drugs and common drugs of abuse.

In some instances claims for LTC (Long Term Care) members have been approving for a day supply value that is greater than the plan’s LTC day supply limit of 31 days . Effective 1/1/2015, MedImpact will limit claims for LTC members up to the plan’s LTC day supply limit of 31 days (with the exception of smallest unbreakable packages, and any other day supply overrides being used by the plan for maintenance medications). In all other scenarios, the claim will deny if the day supply exceeds the plan’s LTC day supply limit. It is important to note that this logic will apply to all pharmacy types dispensing to LTC members (e.g., Retail, Mail Order, Specialty, etc.).

Participating Pharmacies may be experiencing rejections due to incorrect Member ID numbers that appear on approximately 2,000 Covered Person’s newly issued ID cards for Blue Cross Blue Shield of Illinois Community FHP℠, ICP℠ and MMAI℠.

Effective January 1, 2015, Blue Cross Blue Shield of Illinois, Montana, New Mexico and Oklahoma will be utilizing a new Processor Control Number (PCN) for their Blue Cross Medicare Advantage HMO and PPO Part B business.

Effective January 1, 2015, Prime Therapeutics will begin processing Medicare Part D and Part B claims for Covered Persons of Blue Cross Blue Shield of Illinois (BCBSIL) Blue Cross Medicare Advantage (PPO) and Blue Cross Blue Shield of Texas (BCBSTX) Blue Cross Medicare Advantage (HMO).