Fax Coversheet - PBA Health



Express Scripts: BCBS of Kansas City

Effective March 1, 2016, Blue Cross and Blue Shield of Kansas City’s Blue KC plan will update its Commercial Prescription Drug List (PDL). This will result in some medications moving from Tier 2 to Tier 3. These medications will reject with 75 (Prior Authorization Required). If members cannot find an alternative medication that works, then a prior authorization may be requested to allow the Tier 3 drug (step therapy).

MeridianRx

MeridianRx will assume the responsibilities of pharmacy benefit management and claims processing for US-Rx Care and ApproRx. Beginning March 1, 2016 please update your software to reflect the following:

|PCN |Plan/Group |Group ID |BIN |Line of Business |

|9999 |US-Rx Care |Refer to ID Card |017076 |Commercial |

|RXCOMP |ApproRx |Refer to ID Card |610241 |Commercial |

U.S. Script: Peach State Plan

If you receive the reject message “Submit Bill to Other Processor or Primary Payor” then U.S. Script and Peach State Health Plan have been given an alternative carrier’s insurance information. This information can be found in the NCPDP response area in your system (please contact your IT help desk if you need assistance in locating this area). If the alternative carrier is no longer active please contact the U.S. Script Help Desk at 800.460.8988 for additional assistance. U.S. Script will work with pharmacies directly to resolve the issue. Please do not direct the member to contact Peach State Health Plan for resolution.

Express Scripts: NY, AZ, CA, FL, MD, NC, SC, TX, NV, PA, and VA

Beginning March 1, 2016, Express Scripts will administer the prescription drug benefit for City of Buffalo members. This includes members in the Medicare Part D Employer Group Waiver Plan (EGWP). EGWP members reside in many states as indicated above. Please process City of Buffalo active member claims as shown:

|BIN |003858 |

|PCN |A4 |

|RxGroup |BUFFALO |

Please process City of Buffalo EGWP Med D member claims as shown:

|BIN |610014 |

|PCN |MEDDPRIME |

|RxGroup |COBRETRX |

Express Scripts-Anthem-Amerigroup GA Medicaid Emergency Fill

Anthem-Amerigroup Georgia Medicaid allows for 72 hour emergency fills. If claims reject with NCPDP reject code MR “Drug Not Formulary”, per the secondary messaging, please follow the instructions to dispense a 72 hour emergency supply until a Prior Authorization can be obtained. Please process Anthem claims using the following information:

|BIN: |003858 |

|PCN: |MA |

|RxGroup: |WKJA |

Caremark: Aetna Better Health of Kentucky

Aetna Better Health of Kentucky will implement the Does Optimization Program. This program is designed to reduce the number of medication doses a member takes by offering the choice to a single daily dose at a higher strength. If a member is taking a drug that qualifies for this program it will reject with the message: USE HIGHER STRENGHT, 1 PER DAY. After contacting the prescriber, please reprocess the claim using the higher strength/reduced quantity.

MedImpact: Excellus Managed Medicaid-BIN 003585 PCN 74000

Excellus will temporarily allow coverage of ProAir HFA and ProAir RespiClick products due to the shortage of Ventolin HFA. This is effective until March 4, 2016. If necessary, please call the pharmacy help desk at 1.800.724.5033 for an override.

Express Scripts: Pharmacy Type

Some pharmacies have been submitting claims to Express Scripts with the incorrect Pharmacy Service Type Value of 06. This indicates a mail order pharmacy. If your pharmacy is contracted as community retail then Pharmacy Service Type Value 01 needs to be submitted. The NCPDP fields are referenced below.

|NCPDP Field # |NCPDP Field Name |Value |

|147-U7 |Pharmacy Service Type |01=Community Retail |

| | |03=Home Infusion Therapy |

| | |05=Long Term Care |

Prime Therapeutics: BCBS of Alabama

Beginning March 1, 2016, ALL KIDS, a group under Blue Cross Blue Shield of Alabama, is adding vaccine coverage for covered persons. Active members in this group have the option to receive vaccinations for influenza, Pneumovax, Tetanus, Diphtheria and Pertussis, when administered by a pharmacist at a participating pharmacy. Members present their ID card to a participating pharmacy to receive their vaccinations at no charge. Pharmacies must submit the vaccine claim to Prime electronically, which includes the applicable ingredient cost, dispensing fee and vaccine administration fee as a single claim. Pharmacies are reimbursed an administrative fee in addition to the cost of the vaccine product.

-----------------------

[pic]

TriNet Third Party Network

Jim Young, J.D.

Director of Third Party Services

Alicia Janeski, MHA, CPhT

Manager of TriNet Client Services

Danyelle Ferguson

Third Party Specialist

Lindsey Payne, CPhT

Third Party Specialist

Jessica Bruner

Third Party Specialist

Jodi Matthews

Senior Pricing Analyst

Comprehensive Third Party Support Services including:

• Audit Guidance

• Contracts

• Medicare Part D Updates

• Online Member Portal

• PBM Updates

• Pharmacy Support

• Pricing Appeals

• Processing Rejections

If you do not wish to receive future faxes from TriNet, please

call 800-301-3901 or

fax 816-245-5702

to unsubscribe.

TriNet Third Party Network

Phone: 800-333-8097

Fax: 816-245-5705

TriNet@



6300 Enterprise Road

Kansas City, Missouri 64120

Third Party Update

[pic]

TriNet Third Party Network

Jim Young, J.D.

Director of Third Party Services

Alicia Janeski, MHA, CPhT

Manager of TriNet Client Services

Danyelle Ferguson

Third Party Specialist

Lindsey Payne, CPhT

Third Party Specialist

Jessica Bruner

Third Party Specialist

Jodi Matthews

Senior Pricing Analyst

Comprehensive Third Party Support Services including:

• Audit Guidance

• Contracts

• Medicare Part D Updates

• Online Member Portal

• PBM Updates

• Pharmacy Support

• Pricing Appeals

• Processing Rejections

If you do not wish to receive future faxes from TriNet, please

call 800-301-3901 or

fax 816-245-5702

to unsubscribe.

TriNet Third Party Network

Phone: 800-333-8097

Fax: 816-245-5705

TriNet@



6300 Enterprise Road

Kansas City, Missouri 64120

Third Party Update

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download