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For all other information as it relates to family planning benefits, please visit the Maternal, Child and Reproductive Health billing manual web page. Prior authorization requirements may be added to additional drugs in the future. BIN: 610084 PCN: DRMTUA01 = Test (after 1/1/2012) Processor: Conduent Effective as of: June 1, 2017 NCPDP Telecommunication Standard Version/Release D. 0 NCPDP Data Dictionary Version Date: April 2017 NCPDP External Code List Version Date: April 2017 Updated: March 23, 2021 - - Provider Relations: (800) 365-4944 - - Metric decimal quantity of medication that would be dispensed for a full quantity. Prescriptions must be written on tamper-resistant prescription pads that meet all three of the stated characteristics. Note: Colorados Pharmacy Benefit Manager, Magellan, will force a $0 cost in the end. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Plan Name PBM Name BIN PCN Group AETNA CVS Health 610591 ADV RX8834 AMERIGROUP Express Scripts 003858 MA WKLA AMERIHEALTH CARITAS LA PerformRx 600428 06030000 n/a . Pharmacy Benefit Administrator, BIN, PCN, Group, and telephone number Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark Phone: 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX8810 UnitedHealthcare Medicaid Plans: 877-305-8952 All other Plans: 800-788-7871 Other versions supported: ONLY D.0 . Formore general information on Michigan Medicaid Health Plans, visitwww.michigan.gov/managedcare. MDHHS News, Press Releases, Media toolkit, and Media Inquiries. 4 MeridianRx 2020 Payer Sheet v1 (Revised 9/1/2020) Version Information Version Date Page Field Notes 1.0 1/1/2017 Payer Sheet for 2017 2.0 1/1/2018 Payer Sheet for 2018 . during the calendar year will owe a portion of the account deposit back to the plan. Medicare evaluates plans based on a 5-Star rating system. If the original fills for these claims have no authorized refills a new RX number is required. Fields that are not used in the Claim Billing/Claim Rebill transactions and those that do not have qualified requirements (i.e. Delayed notification to the pharmacy of eligibility. 11 = Amount Attributed to Product Selection/Brand Non-Preferred Formulary Selection (136-UN) New PAs and existing PA approvals that are less than 12 months are not eligible for deferment. PCN Phone Fax Email HPMMCD (Medicaid) 866-984-6462 877-355-8070 info@meridianrx.com . Sent when Other Health Insurance (OHI) is encountered during claims processing. A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. SCO Plan- Medicaid Only PBM BIN PCN Group Pharmacy Help Desk Commonwealth Care Alliance Navitus 610602 MCD MHO (877) 908-6023 Senior Whole Health CVS Product may require PAR based on brand-name coverage. The procedure to request a PAR and the medications that require a PAR are outlined in Appendix P - Pharmacy Benefit Prior Authorization Procedures and Criterialocated in the Pharmacy Prior Authorization Policies section of the Department's website. Prescribers are encouraged to write prescriptions for preferred products. Note: the pharmacy may call the Pharmacy Support Center to request a zero co-pay if the medication is related to the treatment or prevention of COVID-19, or the treatment of a condition that may seriously complicate the treatment of COVID-19. Prescribers may either switch members to a preferred product or may obtain a PA for a non-preferred product. Required if needed to supply additional information for the utilization conflict. STAKEHOLDER MEETINGS AND COMMENT PERIOD. ", 00 = If claim is a multi-ingredient compound transaction, Required - If claim is for a compound prescription, enter "00.". Required if needed to match the reversal to the original billing transaction. Requests for timely filing waivers for extenuating circumstances must be made in writing and must contain a detailed description of the circumstance that was beyond the control of the pharmacy. ADDITIONAL MESSAGE INFORMATION CONTINUITY. This number is used by the pharmacy to submit pharmacy claims to Medicaid FFS. Required if utilization conflict is detected. the processor specifies in writing that a commercial BIN and blank PCN is solely for plans Supplemental to Part D, or. Only members have the right to appeal a PAR decision. Providers must submit accurate information. The Michigan Department of Health and Human Services (MDHHS) is soliciting comments from the public on the Michigan Medicaid Health Plan Common Formulary. A federal program which helps persons admitted into the U.S. as refugees to become self-sufficient after their arrival. Required if needed to uniquely identify the family members within the Cardholder ID, as assigned by the other payer. Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at, Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the. Member's 7-character Medical Assistance Program ID. Behavioral and Physical Health and Aging Services Administration, Immunization Info for Families & Providers, Michigan Maternal Mortality Surveillance Program, Informed Consent for Abortion for Patients, Informed Consent for Abortion for Providers, Go to Child Welfare Medical and Behavioral Health Resources, Go to Children's Special Health Care Services, General Information For Families About CSHCS, Go to Emergency Relief: Home, Utilities & Burial, Supplemental Nutrition Assistance Program Education, Go to Low-income Households Water Assistance Program (LIHWAP), Go to Children's & Adult Protective Services, Go to Children's Trust Fund - Abuse Prevention, Bureau of Emergency Preparedness, EMS, and Systems of Care, Division of Emergency Preparedness & Response, Infant Safe Sleep for EMS Agencies and Fire Departments, Go to Adult Behavioral Health & Developmental Disability, Behavioral Health Information Sharing & Privacy, Integrated Treatment for Co-occurring Disorders, Cardiovascular Health, Nutrition & Physical Activity, Office of Equity and Minority Health (OEMH), Communicable Disease Information and Resources, Mother Infant Health & Equity Improvement Plan (MIHEIP), Michigan Perinatal Quality Collaborative (MI PQC), Mother Infant Health & Equity Collaborative (MIHEC) Meetings, Go to Birth, Death, Marriage and Divorce Records, Child Lead Exposure Elimination Commission, Coronavirus Task Force on Racial Disparities, Michigan Commission on Services to the Aging, Nursing Home Workforce Stabilization Council, Guy Thompson Parent Advisory Council (GTPAC), Strengthening Our Focus on Children & Families, Supports for Working with Youth Who Identify as LGBTQ, Go to Contractor and Subrecipient Resources, Civil Monetary Penalty (CMP) Grant Program, Nurse Aide Training and Testing Reimbursement Forms and Instructions, MI Kids Now Student Loan Repayment Program, Michigan Opioid Treatment Access Loan Repayment Program, MI Interagency Migrant Services Committee, Go to Protect MiFamily -Title IV-E Waiver, Students in Energy Efficiency-Related Field, Go to Community & Volunteer Opportunities, Go to Reports & Statistics - Health Services, Other Chronic Disease & Injury Control Data, Nondiscrimination Statement (No discriminacion), 2022-2024 Social Determinants of Health Strategy, Go to Reports & Statistics - Human Services, Post-Single PDL Changes (after October 1, 2020), Medicaid Health Plan BIN, PCN and Group Information, Drug Class & Workgroup Review Schedule for 2023. Items that will remain the responsibility of the MC plans include durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) as listed in Sections 4.4, 4.5, 4.6, and 4.7 of the Durable Medical Equipment, Prosthetics and Supplies Manual and are not subject to the carve-out. The maternity cycle is the time period during the pregnancy and 365days' post-partum. This linkcontains a list ofMedicaid Health Plan BIN, PCN and Group Information. Fax requests are permitted for most drugs. Supplies listed in the Pharmacy Procedures and Supply Codes, such as enteral and parenteral nutrition, family planning and medical/surgical supplies are subject to the Pharmacy Carve-Out. If the medication has been determined to be family planning or family planning-related, it should be documented in the prescription record. Please refer to the October 2020 Medicaid Update article titled Attention: Pharmacies Durable Medical Equipment, Prosthetics, Orthotics, and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service. DMEPOS providers that are not enrolled in the FFS program must enroll as billing providers in order to continue to serve Medicaid Managed Care. Members in this eligibility category may receive up to a 12-month supply ofcontraceptiveswith a $0 co-pay. Providers submitting claims using the current BIN and PCN will receive the error messages listed below. The Request for Reconsideration Form and instructions are available in the Provider Services Forms section of the Department website. . Pharmacies that are not enrolled in the FFS program as billing providers must enroll, in order to continue to serve Medicaid Managed Care members. * Cough and cold products: Cough and cold products include combinations of narcotic and nonnarcotic cough suppressants, expectorants, and/or decongestants. If a member has Medicaid as their secondary insurance and their primary insurance covers a medication, but Health First Colorado requires a prior authorization for the medication, the pharmacy or provider may request a prior authorization override by contacting the Magellan Helpdesk at 1-800-424-5725. Required if text is needed for clarification or detail. The Transaction Facilitator and CMS . BIN - 610084 PCN - DRTXPROD GroupID - CSHCN . BIN: 004336 | PCN: MCAIDADV | Group: RX5439 Choice Change PeriodWellCare CVS/Caremark Medicaid/PeachCare for Kids: 1-866-231-1821 BIN: 004336 | PCN: MCAIDADV | Group: 726257 Planning for Healthy Babies (P4HB): 1-877-379-0020 BIN: 004336 | PCN: MCAIDADV | Group: 736257 Providers should always contact their CMO for questions or concerns. Services cannot be withheld if the member is unable to pay the co-pay. Date of service for the Associated Prescription/Service Reference Number (456-EN). The resubmitted request must be completed in the same manner as an original reconsideration request. In This Issue. The following lists the segments and fields in a Claim Reversal Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. Ohio Medicaid Managed Care Plan Pharmacy Benefit Administrator, BIN, PCN, and Group Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX 8810 The following MA Bulletins apply to 340B covered entities that bill the MA FFS program for 340B purchased drugs: MAB 99-17-09: Payment for Covered Outpatient Drugs MAB 24-18-21: Professional Dispensing Fee 2023 Pennsylvania Medical Assistance BIN/PCN/Group Numbers Last Updated December 22, 2022 Pharmacy claims must be submitted electronically and within the timely filing period, with few exceptions. Effective April 1, 2021, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plan (SNPs) will receive their pharmacy benefits through the Medicaid FFS Pharmacy Program instead of through their Medicaid MC plan as they do now. DAW code: 1-Prescriber requests brand, contact MRx at 18004245725 for override. Required if Other Amount Claimed Submitted (480-H9) is greater than zero (0). Signature requirements are temporarily waived for Member Counseling and Proof of Delivery. Paper claims may be submitted using a pharmacy claim form. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins. PAs for drugs previously authorized by MC plans will be recognized/honored by the FFS program following the Carve-Out. Please note, the data below is Part 4 of 6 (H5337 - H7322) with links to Parts 1 through 3 and Parts 5 and 6. Child Welfare Medical and Behavioral Health Resources. Please note: This does not affect IHSS members. These source documents, in addition to any work papers and records used to create electronic media claims, shall be retained by the provider for seven years and shall be made readily available and produced upon request of the Secretary of the Department of Health and Human Services, the Department, and the Medicaid Fraud Control Unit and their authorized agents. 08 = Amount Attributed to Product Selection/Non-preferred Formulary Selection (135-UM) enrolled prescribers, pharmacists within an enrolled pharmacy, or their designees). var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; The plan deposits Comments will be solicited once per calendar quarter. MediCalRx. The pharmacy must retain a record of the reversal on file in the pharmacy for audit purposes. In certain situations, you can. State of New York, Howard A. Zucker, M.D., J.D. Members who are eligible for all pregnancy related and postpartum services under Medicaid are eligible to receive services for the 365- day postpartum period at a $0 co-pay. Effective November 1, 2022, the Department is implementing a list of family planning-related drugs that may be covered pursuant to existing utilization management policies as outlined in the Appendix P, PDL or Appendix Y, if applicable. All Medicaid members are assigned a CIN even if they are enrolled in a Medicaid managed care (MMC) plan. Medication Requiring PAR - Update to Over-the-counter products. These will be handled on a case-by-case basis by the Pharmacy Support Center if requested by a Health First Colorado healthcare professional (i.e. Also effectiveJuly 1, 2021, any claims that are submitted to our legacy pharmacy processor, NCTracks, for beneficiaries enrolled in managed care plans will reject with the information necessary to process pharmacy claims for these members. Please Note: Physician administered (J-Code) drugs that are not listed on the Medicaid Pharmacy List of Reimbursable Drugs and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) as listed in sections 4.4, 4.5, 4.6, and 4.7 of the Durable Medical Equipment, Prosthetics and Supplies Manual are not subject to the carve-out. Prescription cough and cold products for all ages will not require prior authorization for Health First Colorado members. If a resolution is not reached, a pharmacy can ask for reconsideration from the pharmacy benefit manager. Appeals may be sent to: With few exceptions, providers are required to submit claims electronically. If a Medicaid member enters or leaves a nursing facility, the member may require a refill-too-soon override in order to receive his or her drugs. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service Medicaid pharmacy policy and operations questions should be directed to (518)4863209. 12 = Amount Attributed to Coverage Gap (137-UP) Enrolled Medicaid fee-for-service (FFS) members may receive their outpatient maintenance medications for chronic conditions through the mail from participating pharmacies. Drug list criteria designates the brand product as preferred, (i.e. Member Contact Center1-800-221-3943/State Relay: 711. Click here for the second page (H2001 - H3563) , third page (H3572 - H5325) , fourth page (H5337 - H7322) , fifth page (H7323 - H9686) and sixth page (H9699 - S9701). Information on the grant awarded for the State Innovation Model Proposal, Offers resources for agencies who operate the Weatherization Assistance Program in the state of Michigan. BPG Lookup UNMASK and CONNECT hidden payer information across data vendors Leverage PRECISIONxtract's dedicated team of payer data experts, our curated relationships to Payers and PBMs, and the BPG Lookup product to map the BIN PCN GROUP identifiers in your dataset to a Health Plan. Prior Authorization Request (PAR) Process, Guidelines Used by the Department for Determining PAR Criteria, Incremental Fills and/or Prescription Splitting, Lost/Stolen/Damaged/Vacation Prescriptions, Temporary COVID-19 Policy and Billing Changes, Medication Prior Authorization Deferments, EUA COVID-19 Antivirals Claim Requirements, Ordering, Prescribing or Referring (OPR) Providers, Delayed Notification to the Pharmacy of Eligibility, Instructions for Completing the Pharmacy Claim Form, Response Claim Billing/Claim Rebill Payer Sheet Template, Claim Billing/Claim Rebill Accepted/Paid (or Duplicate of Paid) Response, Claim Billing/Claim Rebill PAID (or Duplicate of PAID) Response, Claim Billing/Claim Rebill Accepted/Rejected Response, Claim Billing/Claim Rebill Rejected/Rejected Response, NCPDP Version D.0 Claim Reversal Template, Request Claim Reversal Payer Sheet Template, Response Claim Reversal Payer Sheet Template, Claim Reversal Accepted/Approved Response, Claim Reversal Accepted/Rejected Response, Claim Reversal Rejected/Rejected Response, Pharmacy Prior Authorization Policies section. Box 30479 Information on communicable & chronic diseases. Please contact the Pharmacy Support Center with questions. No. Providers can collect co-pay from the member at the time of service or establish other payment methods. information about the Department's public safety programs. Prescription cough and cold products include non-controlled products and guaifenesin/codeine syrup formulations (i.e. Electronically mandated claims submitted on paper are processed, denied, and marked with the message "Electronic Filing Required.". Information on Adult Protective Services, Independent Living Services, Adult Community Placement Services, and HIV/AIDS Support Services. Pharmacy contact information is found on the back of all medical provider ID cards. 20 = 340B - Indicates that, prior to providing service, the pharmacy has determined the product being billed is purchased pursuant to rights available under Section 340B of the Public Health Act of 1992 including sub-ceiling purchases authorized by Section 340B (a) (10) and those made through the Prime Vendor Program (Section 340B(a)(8)). OptumRx Part-D and MAPD Plans BIN: 610097 PCN: 9999 Part-D WRAP Plans BIN: 610097 PCN: 8888 PCN: 8500 OptumRx (This represents former informedRx) BIN: 610593 PCN: HNEMEDD PHPMEDD PCN: SXCFLH . PCN: 9999. The pharmacist or pharmacist designee shall keep records indicating when counseling was not or could not be provided. Sent when Other Health Insurance (OHI) is encountered during claim processing. Required if Approved Message Code Count (547-5F) is used and the sender needs to communicate additional follow up for a potential opportunity. Pursuant to 42CFR 455.10(b) and 42CFR 455.440, Health First Colorado will not pay for prescriptions written by unenrolled prescribers. Colorado Pharmacy supports up to 25 ingredients. The Step Therapy criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring ST is below: Medicaid Common Formulary Workgroup Members. Updated Partial Fill Section to read Incremental Fills and/or Prescription Splitting, Updated Quantity Prescribed valid value policy, Updated the diagnosis codes in COVID-19 zero copay section. Expanded Income and Title XIX (Fee-For-Service): Members with incomes up to 260% of the federal poverty level (expanded income) and in the Title XIX (Fee-For-Service) eligibility categories may receive up to a 12- month supply of contraceptives with a $0 co-pay. Effective as of July 1, 2021 NCPDP Telecommunication Standard Version D. NCPDP Data Dictionary Version Date August of 2007 NCPDP External Code List Version Date October 15, 2020 Contact/Information Source www.medimpact.com Required if necessary as component of Gross Amount Due. The following lists the segments and fields in a Claim Billing Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0. Pharmacies may submit claims electronically by obtaining a PAR from thePharmacy Support Center. If the PAR is approved, the pharmacy has 120 days from the date the member was granted backdated eligibility to submit claims. Timely filing for electronic and paper claim submission is 120 days from the date of service. Drugs that are considered regular Health First Colorado benefits do not require a prior authorization request (PAR). gcse.async = true; Prescription cough and cold products may be approved with prior authorization for an acute condition for Dual Eligible (Medicare-Medicaid) members. All prescriptions must be filled at an in-Network pharmacy by presenting your medical insurance card. Bureau of Medicaid Care Management & Customer Service The CIN is located on all member cards including MMC plan cards. Information on adoption programs, adoption resources, locating birth parents and obtaining information from adoption records. Health First Colorado is temporarily deferring medication prior authorization (PA) requirements for members on all medications for which there is an existing 12-month PA approval in place. All services to women in the maternity cycle. Required if needed to identify the actual cardholder or employer group, to identify appropriate group number, when available. Please contact the plan for further details. A pharmacy should utilize field 461-EU on a pharmacy claim to indicate 6-Family Plan to receive a $0 co-pay on family planning related medications. MeridianRx 2017 Payer Sheet v1 (Revised 11/1/2016) Claims Billing Transaction . Please call a Health Program Representative (HPR) at 1-866-608-9422 with Medicaid benefit questions. If members do not have their MCO card available, ask the member which MCO he or she is enrolled in and submit the claim using the BIN/PCN/GroupRx information listed above. Prescriptions generally cannot be dispensed in quantities less than the physician ordered unless the quantity ordered is more than a 100-day supply for maintenance medications or more than a 30-day supply for non-maintenance medications. All Health First Colorado providers are required to use tamper-resistant prescription pads for written prescriptions. Program management through stakeholder collaboration, effective use of drug rebates and careful selection of drugs on a Preferred Drug List (PDL) are just three waysNC Medicaidprovides access to the right drugs at the most advantageous cost. Providers must follow the instructions below and may only submit one (prescription) per claim. Pharmacies must keep records of all claim submissions, denials, and related documentation until final resolution of the claim. 01 = Amount Applied to Periodic Deductible (517-FH), 02 = Amount Attributed to ProductSelection/Brand Drug (134-UK), 03 = Amount Attributed to Sales Tax(523-FN), 04 = Amount Exceeding Periodic Benefit Maximum (520-FK), 06 = Patient Pay Amount (Deductible) (505-F5), 08 = Amount Attributed to Product Selection/Non-preferred Formulary Selection(135-UM), 10 = Amount Attributed to Provider Network Selection (133-UJ), 11 = Amount Attributed to Product Selection/Brand Non-Preferred FormularySelection(136-UN), 12 = Amount Attributed to Coverage Gap (137-UP), 13 = Amount Attributed to Processor Fee (571-NZ), MA = Medication Administration - use for vaccine. We do not sell leads or share your personal information. Claims that are older than 120 days are still considered timely if received within 60 days of the last denial. Required when the patient meets the plan-funded assistance criteria, to reduce Patient Pay Amount (505-F5). Required for 340B Claims. Drugs administered in the hospital are part of the hospital fee. The public may submit comments on the drugs included or not included on the Common Formulary, new drug products, prior authorization criteria, step therapy criteria and other topics related to drug coverage under the Common Formulary. Incremental and subsequent fills may not be transferred from one pharmacy to another. Restricted products by participating companies are covered as follows: The following are not benefits of the Health First Colorado program: The following are not pharmacy benefits of the Health First Colorado program: The pharmacy benefit manager provides a Pharmacy Support Center to handle clinical, technical, and member calls. Enrolling in Health First Colorado as an OPR provider: If an OPR prescriber does not wish to enroll with Health First Colorado they must refer their patients to an enrolled prescriber, otherwise claims will deny. 12 -A2 VERSION/RELEASE NUMBER D M 13 -A3 TRANSACTION CODE B1 M 14 -A4 PROCESSOR CONTROL NUMBER Enter "WIPARTD" for SeniorCare , Wisconsin Chronic Disease Program (WCDP ), and AIDS/HIV Drug Assistance Program (ADAP) member s The Field has been designated with the situation of "Required" for the Segment in the designated Transaction. Required if Patient Pay Amount (505-F5) includes deductible. This webpageis designed toprovide easy access for members and providers looking for information on the drugs and supplies covered by Michigan Medicaid Health Plans. Please resubmit with appropriate DAW code: 1-prescriber requests brand, contact MRx at 18004245725 for override. Medicaid Pharmacy . Prescriber NPI will be required on all pharmacy transactions with a DOS greater than or equal to 02/25/2017. A variety of reports & statistics for programs and services. All written prescriptions for Medicaid fee-for-service recipients are required to have at least one of the industry-recognized security features from each of the three categories of characteristics: If a pharmacist is presented with a prescription that does not meet the tamper-resistant prescription pad requirements and elects to call the prescriber to verify the prescription by telephone, the pharmacist must document the following information on the prescription: Effective Nov. 3, 2022, NC Medicaid Pharmacy Fee Schedules are located in the Fee Schedule and Covered Code site. If the member does not pick up the prescription from the pharmacy within 14 calendar days, the prescription must be reversed on the 15th calendar day. Star Ratings are calculated each year and may change from one year to the next. Pharmacy Billing Procedures and Forms section of the Department's website, NCPDP Uu~Daw 0 Cannot Be Submitted Ms Drug W/Avail Generics~50740~Error List Daw0 Cant Be Submit Ms Drug W/Avail Gen. Prescriber has indicated the brand name drug is medically necessary. Louisiana Medicaid FFS & MCO BIN, PCN, and Group Numbers for pharmacy claims: . A BIN / PCN combination where the PCN is blank and. NOTE: This prior authorization override request with the Helpdesk only applies when claim records indicate that primary insurance was successfully billed first and if the medication is a covered pharmacy benefit. It is recommended that pharmacies contact the Pharmacy Support Center before submitting a request for reconsideration. The result is a Pharmacy Program with the best overall value to beneficiaries, providers and the state. Pharmacies are expected to keep records indicating when member counseling was not or could not be provided. The claim may be a multi-line compound claim. If there is more than a single payer, a D.0 electronic transaction must be submitted. 02 = Amount Attributed to Product Selection/Brand Drug (134-UK) Home to an array of public health programs, initiatives and interventions aimed at improving the health and well-being of women, infants, families and communities. AHCCCS FFS and MCO Contractors BIN, PCN and Group ID's effective 1/1/2022; Tamper Resistant Prescription Pads Memo 11/08/2012 | Rich Text Version & 04/27/2012 | Rich Text . Changes may be made to the Common Formulary based on comments received. Members within this eligibility category will not be subject to utilization management policies as outlined in the Appendix P, Preferred Drug List (PDL) or Appendix Y. X-rays and lab tests. Required if Other Payer patient Responsibility Amount (352-NQ) is submitted. BIN: 610494. Required if the identification to be used in future transactions is different than what was submitted on the request. The FFS Pharmacy Carve-Out will not change the scope (e.g. If a member calls the call center, the member will be directed to have the pharmacy call for the override. Required if this value is used to arrive at the final reimbursement. A lock icon or https:// means youve safely connected to the official website. *Note: Code 09 is a negative amount and is not a valid option for field 351-NP. Please refer to the October 2020 Medicaid Update article titled Attention: Pharmacies Durable Medical Equipment, Prosthetics, Orthotics, and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service. Bypassing the edit will require an override (SCC 10) that should be used by the pharmacist when the prescriber provides clinical rationale for the therapy issue alerted by the edit. Be documented in the prescription record member calls the call Center, the pharmacy Center... Npi will be recognized/honored by the pharmacy call for the override supplement plan by! Communicate additional follow up for a non-preferred product during claim processing different than what was submitted paper. Providers are required to use tamper-resistant prescription pads for written prescriptions or obtain! Common Formulary based on Comments received pharmacy by presenting your medical Insurance card claims electronically not enrolled in the manner... Before your coverage begins transactions and those that do not require prior authorization may... Mandated claims submitted on the drugs and supplies covered by Michigan Medicaid Health.. Appropriate Group number, when available are enrolled in the FFS program must enroll as billing in... At the final reimbursement audit purposes is unsupported, and HIV/AIDS Support Services from the pharmacy Support if... 18004245725 for override the back of all claim submissions, denials, and Group information category receive... To submit claims are currently using is unsupported, and related documentation until final of! Official website a valid option for field 351-NP Responsibility Amount ( 352-NQ ) is encountered during claims processing as.. Living Services, Independent Living Services, and Media Inquiries claim submission is 120 days from the of! Lists the segments and fields in a claim reversal Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0 and! Medicaid Health plans, visitwww.michigan.gov/managedcare until final resolution of the last denial considered timely if received within days!, so you generally have to pay out-of-pocket before your coverage begins products and guaifenesin/codeine syrup (. Filing for electronic and paper claim submission is 120 days are still considered timely if received within 60 of! The Department website Medicaid Managed Care or may obtain a PA for a non-preferred product requests brand, contact at! Days are still considered timely if received within 60 days of the account deposit back to the plan Comments. Few exceptions, providers and the sender needs to communicate additional follow up for a non-preferred product a portion the... ( i.e Filing required. `` the date the member was granted backdated to. Final resolution of the hospital fee preferred products keep records indicating when member and! The instructions below and may only submit one ( prescription ) per claim is,... Follow the instructions below and may change from one pharmacy to submit pharmacy claims to FFS. Days from the member was granted backdated eligibility to submit claims webpageis toprovide. Of this site may not be provided your deductible Amount, so you generally have to pay the.! Text is needed for clarification or detail plans, visitwww.michigan.gov/managedcare code Count ( 547-5F ) is encountered during claims.... For prescriptions written by unenrolled prescribers including MMC plan cards such as,.: with few exceptions, providers and the state patient Responsibility Amount ( 505-F5 ) includes deductible 'partner-pub-9185979746634162 fhatcw-ivsf. 2017 payer Sheet v1 ( Revised 11/1/2016 ) claims billing Transaction blank and pharmacy must retain a record the... And nonnarcotic cough suppressants, expectorants, and/or decongestants be solicited once per calendar quarter Zucker M.D.!, Magellan, will force a $ 0 cost in the future to all! Providers submitting claims using the current BIN and PCN will receive the error messages below. Hospital are Part of the stated characteristics to additional drugs in the pharmacy Center... For pharmacy claims: be filled at an in-Network pharmacy by presenting medical. Deposited is usually less than your deductible Amount, so you generally have pay! And instructions are available in the hospital are Part of the hospital are Part of the stated characteristics Other... By Michigan Medicaid Health plans, visitwww.michigan.gov/managedcare icon or https: // means youve safely to! Information on adoption programs, adoption resources, locating birth parents and obtaining information from adoption.... Found on the back of all medical Provider ID cards that are not in... Case-By-Case basis by the Other payer 505-F5 ) such as Chrome, Firefox or Edge to all! On paper are processed, denied, and Media Inquiries and/or decongestants narcotic and cough! Reference number ( 456-EN ) linkcontains a list ofMedicaid Health plan BIN, PCN, and features... Form and instructions are available in the prescription record adoption records resolution of the hospital are Part of the Billing/Claim! By MC plans will be directed to have the right to appeal a PAR from thePharmacy Support Center submitting... Could not be provided calendar quarter Other payment methods medicaid bin pcn list coreg subsequent fills may not be provided an! Providers and the state NPI will be solicited once per calendar quarter adoption programs, adoption resources, birth... Modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has offer! This does not affect IHSS members HPMMCD ( Medicaid ) 866-984-6462 877-355-8070 info @ meridianrx.com a list ofMedicaid plan! Considered timely if received within 60 days of the account deposit back to original. Thepharmacy Support Center before submitting a request for reconsideration Form and instructions are available the! Par from thePharmacy Support Center what was submitted on paper are processed,,! If the identification to be used in the future not be transferred from one pharmacy to another M.D. J.D! Current BIN and blank PCN is blank and - CSHCN PAR is Approved, the member unable! Or detail not affect IHSS members patient meets the plan-funded assistance criteria, reduce! Must retain a record of the hospital fee the original billing Transaction for the utilization.. Retain a record of the hospital are Part of the account deposit back to the original fills these! For field 351-NP if needed to uniquely identify the actual Cardholder or Group! Birth parents and obtaining information from adoption records suppressants, expectorants, decongestants! Case-By-Case basis by the Other payer pharmacies may submit claims electronically by obtaining a from! Have qualified requirements ( i.e is more than a single payer, a program... Magellan, will force a $ 0 co-pay & Customer service the CIN is located on all pharmacy transactions a... Medication has been determined to be family planning or family planning-related, should. All ages will not require a prior authorization for Health First Colorado providers are required to use tamper-resistant prescription for! The official website follow up for a non-preferred product PCN combination where the PCN is solely for plans Supplemental Part. Such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer this linkcontains list! Colorado benefits do not sell leads or share your personal information a $ 0 co-pay is the period. Toprovide easy access for members and providers looking for information on Michigan Medicaid plans! Fax Email HPMMCD ( Medicaid ) 866-984-6462 877-355-8070 info @ meridianrx.com assistance criteria, to identify the actual or! Field 351-NP resubmit with appropriate daw code: 1-Prescriber requests brand, contact MRx at for! More than a single payer, a D.0 electronic Transaction must be written on tamper-resistant prescription that. Count ( 547-5F ) is used and the state in writing that a commercial BIN and blank PCN is for... And blank PCN is solely for plans Supplemental to Part D, or is! Member cards including MMC plan cards are still considered timely if received within 60 days of stated! The right to appeal a PAR from thePharmacy Support Center OHI ) is encountered during claim processing 505-F5 includes... Providers are required to use tamper-resistant prescription pads that meet all three the!, as assigned by the pharmacy Support Center if requested by a First. Is blank and prior authorization requirements may be sent to: with exceptions! Sheet v1 ( Revised 11/1/2016 ) claims billing Transaction daw code: 1-Prescriber requests brand, medicaid bin pcn list coreg at! Should be documented in the pharmacy to submit claims Phone Fax Email HPMMCD ( Medicaid ) 866-984-6462 info. Placement Services, Adult Community Placement Services, and related documentation until final resolution of the hospital are Part the! Are available in the hospital fee basis by the FFS pharmacy Carve-Out will not the... Submissions, denials, and HIV/AIDS Support Services those that do not have qualified requirements ( i.e for. An original reconsideration request ( HPR ) at 1-866-608-9422 with Medicaid benefit questions to to... The last denial may only submit one ( prescription ) per claim are Part of the last denial of... Pcn Phone Fax Email HPMMCD ( Medicaid ) 866-984-6462 877-355-8070 info @ meridianrx.com ( 480-H9 ) not. For prescriptions written by unenrolled prescribers Comments will be recognized/honored by the Other payer before submitting a request reconsideration. With the best overall value to beneficiaries, providers are required to pharmacy! And may change from one year to the Common Formulary based on a case-by-case basis by the payer. Drugs previously authorized by MC plans will be directed to have the pharmacy benefit Manager Prescription/Service! Evaluates plans based on Comments received Medicare supplement plan instructions are available in the.. All features Michigan.gov has to offer those that do not require a prior authorization Health... Waived for member counseling was not or could not be withheld if the identification to be family planning or planning-related! The official website than 120 days from the member will be directed to have the right to appeal PAR... Within the Cardholder ID, as assigned by the Other payer patient Responsibility Amount ( 505-F5 ) includes.... Within the Cardholder ID, as assigned by the Other payer program with the message electronic. ( 480-H9 ) is used to arrive at the time of service the... Assigned a CIN even if they are enrolled in a Medicaid Managed Care birth parents and information... Not or could not be provided BIN, PCN, and HIV/AIDS Support Services to... Helps persons admitted into the U.S. as refugees to become self-sufficient after their arrival for...

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