If a resolution is not reached, a pharmacy can ask for reconsideration from the pharmacy benefit manager. Health Care Coverage information and resources. Appeals to the Office of Administrative Courts must be filed in writing within 60 days from the mailing date of the reconsideration denial. Required on all COB claims with Other Coverage Code of 2. Current beneficiaries can find out which health plan theyareenrolled in bycalling the Beneficiary Help Line at 800-642-3195 (TTY 866-501-5656) or bylogging in to theirmyHealth Portal account online atwww.michigan.gov/myhealthportal. This page provides important information related to Part D program for Pharmaceutical companies. 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 The BIN/IIN field will either be filled with the ISO/IEC 7812 IIN or the NCPDP Processor BIN, depending on which one the health plan has obtained. Required if needed by receiver to match the claim that is being reversed. In certain situations, you can. ", 00 = If claim is a multi-ingredient compound transaction, Required - If claim is for a compound prescription, enter "00.". It is recommended that pharmacies contact the Pharmacy Support Center before submitting a request for reconsideration. PCN List for BIN 610241 MeridianRx PCN Group ID Line of Business HPMMCD N/A Medicaid . The Pharmacy Carve-Out does not apply to members enrolled in Managed Long-Term Care plans (e.g., MLTC, PACE and MAP), the Essential Plan, or Child Health Plus (CHP). MassHealth PBM BIN PCN Group Primary Care Clinician (PCC) Plan Scheduled II drugs will deny NCPDP ET M/I Quantity Prescribed. the processor specifies in writing that a commercial BIN and blank PCN is solely for plans Supplemental to Part D, or. Imp Guide: Required, if known, when patient has Medicaid coverage. The Request for Reconsideration Form and instructions are available in the Provider Services Forms section of the Department website. Drugs administered in the hospital are part of the hospital fee. Required on all COB claims with Other Coverage Code of 3, OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT COUNT, Required on all COB claims with Other Coverage Code of 2 or 4, OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT QUALIFIER. New York Managed Medicaid Plans processed by Caremark will cover COVID-19 specimen collection or CLIA waived COVID-19 testing at pharmacies in accordance with the New York Governor's Executive Order #202.24. Copies of all RAs, electronic claim rejections, and/or correspondence documenting compliance with timely filing and 60-day rule requirements must be submitted with the Request for Reconsideration. Copies of all forms necessary for submitting claims are also available on the Pharmacy Resources web page of the Department's website. of the existing Medicaid Pharmacy benefit, which includes: The complete list of items subject to the Pharmacy Benefit Carve-Out can be reviewed in the Carve-Out Scope web page. Drugs administered in clinics, these must be billed by the clinic on a professional claim. A PAR must be submitted by contacting the Pharmacy Benefit Manager Support Center. Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. 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. 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. BIN - 017804 PCN - ILPOP All claims submitted, including historical reversals and resubmissions after the implementation of the new PBMS, must include the new BIN and PCN. Required if Quantity of Previous Fill (531-FV) is used. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Payer: Please list each transaction supported with the segments, fields, and pertinent information on each transaction. Please contact the Pharmacy Support Center for a one-time PA deferment. The information in the chart below will assist enrolled pharmacies in billing point of sale pharmacy claims for these beneficiaries. BIN - 610084 PCN - DRTXPROD GroupID - CSHCN . Payer/Carrier BIN/PCN Date Available Vendor Certification ID 4D d/b/a Medtipster 610209/05460000 Current 601DN30Y Adjudicated Marketing 600428/05080000 Current 601DN30Y Alaska Medicaid 009661 Current 091511D002 Louisiana Department of Health Healthy Louisiana Page 3 of 8 . A Request for Reconsideration will display on the RA as a paid or denied claim without specifying that it is a claim for reconsideration. 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. Incremental and subsequent fills may not be transferred from one pharmacy to another. Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. Prescribers may either switch members to a preferred product or may obtain a PA for a non-preferred product. IV equipment (for example, Venopaks dispensed without the IV solutions). The use of inaccurate or false information can result in the reversal of claims. Required for partial fills. Payer Name: Iowa Medicaid Enterprise Date: August 14, 22 Plan Name/Group Name: Iowa Medicaid BIN:11933 PCN:IAPOP Processor: IME POS Unit (CHC) Effective as of September 21, 22 NCPDP Telecommunication Standard Version/Release #: D. NCPDP Data Dictionary Version Date: July 27 NCPDP External Code List Version Date: April 218 The new BIN and PCN are listed below. 01 = Amount applied to periodic deductible (517-FH) All necessary forms should be submitted to Magellan Rx Management at: There are four exceptions to the 120-day rule: Each of these exceptions is detailed below along with the specific instructions for submitting claims. Medicare evaluates plans based on a 5-Star rating system. MedImpact is the prescription drug provider for all medical Plans. 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. Required for partial fills. You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. M -Mandatory as defined by NCPDP R -Required as defined by the Processor RW -Situational as defined by Plan Transaction Header Segment: Mandatory Field # NCPDP Field Name Value Req Comment 11-A1 BIN Number 004336, 610591 012114, 013089 020396 Instructions for checking enrollment status, and enrollment tips can be found in this article. Pharmacies can also check a member's enrollment with a West Virginia Medicaid MCO by calling 888-483-0793 Prescription cough and cold products may be approved with prior authorization for an acute condition for Dual Eligible (Medicare-Medicaid) members. "P" indicates the quantity dispensed is a partial fill. 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. Members of these eligibility categories will be subject to utilization management policies as outlined in the Appendix P, PDL or Appendix Y. See Appendix A and B for BIN/PCN combinations and usage. Information about injury and violence prevention programs in Michigan. The Medicare Coverage Gap Discount Program (Discount Program) makes manufacturer discounts available to eligible Medicare beneficiaries receiving applicable, covered Part D drugs, while in the coverage gap. This webpageis designed toprovide easy access for members and providers looking for information on the drugs and supplies covered by Michigan Medicaid Health Plans. Information on adoption programs, adoption resources, locating birth parents and obtaining information from adoption records. Bureau of Medicaid Care Management & Customer Service Providers can collect co-pay from the member at the time of service or establish other payment methods. 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. New York State Department of Health, Donna Frescatore Information on the Family Independence Program, State Disability Assistance, SSI, Refugee, and other cash assistance. Required if this field is reporting a contractually agreed upon payment. Required on all COB claims with Other Coverage Code of 3. Access to medical specialists and mental health care. Required when there is payment from another source. Pediatric and Adult Edits Criteria are located at the bottom of the Prior Approval Drugs and Criteria page on NCTracks. Updated Retroactive Member Eligibility, Delayed Notification to the Pharmacy of Eligibility, Extenuating Circumstances and Other Coverage Code definitions. Governor Leading zeroes in the NCPDP Processor BIN are significant. 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. Required if Incentive Amount Submitted (438-E3) is greater than zero (0). BIN 610591 20107 610649 4336 4336 610494 11529 PCN ADV KY 3191501 MCAIDADV MCAIDADV 4040 P022011529 GROUP RX8831 WKVA RX5035 RX8893 ACUKY KY Medicaid PBM CVS Caremark IngenioRx Humana Pharmacy Solutions CVS Caremark CVS Caremark Optum Rx Magellan Kentucky Medicaid Bin/PCN/Group Numbers Effective 1/1/2021. Required when the receiver must submit this Prior Authorization Number in order to receive payment for the claim. A formulary is a list of drugs that are preferred by a health plan. The Pharmacy Support Center is available to answer provider claim submission and basic drug coverage questions. Required if this value is used to arrive at the final reimbursement. Information on the Food Assistance Program, eligibility requirements, and other food resources. Interactive claim submission must comply with Colorado D.0 Requirements. Providers must follow the instructions below and may only submit one (prescription) per claim. Medicaid Pharmacy . These are all of the BIN/PCN/Group ID numbers that will be accepted by ACS: Former Codes New Codes Who BIN PCN from Pharmacy NCPDP Group ID from Pharmacy BIN PCN from Pharmacy NCPDP Group ID from Pharmacy BCCDT 010454 P012010454 MDBCCDT 610084 DRDTPROD MDBCCDT Required if Reason for Service Code (439-E4) is used. Members are instructed to show both ID cards before receiving health care services. The Transaction Facilitator and CMS . 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 This will allow the pharmacist to determine if the medication was prescribed in relation to a family planning visit (e.g., tobacco cessation, UTI and STI/STD medications). Sent if reversal results in generation of pricing detail. 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 . For more information related to physician administered drugs and billing for this population, please visit the Physician-Administered-Drug (PAD) Billing Manual. DAW code: 1-Prescriber requests brand, contact MRx at 18004245725 for override. Instructions for checking enrollment status, and enrollment tips can be found in this article. 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. If the medication has been determined to be family planning or family planning-related, it should be documented in the prescription record. 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. Required if needed to uniquely identify the relationship of the patient to the cardholder ID, as assigned by the other payer. Where should I send the Medicare Part D coordination of benefits (COB) claims? A PAR is only necessary if an ingredient in the compound is subject to prior authorization. Resources and information to assist in assuring firearm safety for families in the state of Michigan. ORDHSFFS : Advanced Health 800-788-2949 003585 38900 AllCare ; 800-788-2949 ; 003585 : MDHHS News, Press Releases, Media toolkit, and Media Inquiries. This dollar amount will be provided, if known, to the receiver when the transaction had spending account dollars reported as part of the patient pay amount. Effective April 1, 2021, the following Medicaid Pharmacy FFS Programs will also apply to Medicaid managed care members: 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. Certain restricted drugs require prior authorization before they are covered as a benefit of the medical assistance program. Basis of Cost Determination = This is not a required field on the claim, but 05 (Acquisition) or 08 (340B/Disproportionate Share Pricing/Public Health Service) will be accepted if submitted on the claim. If the original fills for these claims have no authorized refills a new RX number is required. Please contact the plan for further details. Information about audits conducted by the Office of Audit. Required if needed to match the reversal to the original billing transaction. . 07 = Amount of Co-insurance (572-4U) Medicaid Publication Date June 1, 2021 BIN(s) 023880 PCN(s) KYPROD1 Processor MedImpact Healthcare Systems, Inc. A 7.5 percent tolerance is allowed between fills for Synagis. Information & resources for Community and Faith-Based partners. PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER, ASSOCIATED PRESCRIPTION/SERVICE REFERENCE NUMBER. Updated Lost/Stolen/Damaged/Vacation Prescriptions section - police report is no longer required for Stolen Medications, PAR Process: Updated notification letter section, Partial Fills and/or Prescription: Updated partial fill criteria, Updated contact information on page 15, to include Magellan's helpdesk info. The Prior Authorization criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring PA is below: A standard prior authorization form, FIS 2288, was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription drugs. Please Note: Incremental and subsequent fills are not permitted for compounded prescriptions. Signature requirements are temporarily waived for Member Counseling and Proof of Delivery. Source documents and source records used to create pharmacy claims shall be maintained in such a way that all electronic media claims can be readily associated and identified. Health First Colorado is waiving co-pay amounts for medications related to COVID-19 when ICD-10 diagnosis code U07.1, U09.9, Z20.822, Z86.16, J12.82, Z11.52, B99.9, J18.9, Z13.9, M35.81, M35.89, Z11.59, U07.1, B94.8, O98.5, Z20.818, Z20.828, R05, R06.02, or R50.9 is entered on the claim transmittal. The PCN has two formats, which are comprised of 10 characters: 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. These values are for covered outpatient drugs. The PCF should be submitted to Magellan Rx Management agent at: Below are the completion instructions for the Colorado Pharmacy Claim Form (PCF-2) for Pharmacy Providers. Required if Other Payer Amount Paid (431-DV) is greater than zero (0) and Coordination of Benefits/Other Payments Segment is supported. Quantity Prescribed (Field # 460-ET) for ALL DEA Schedule II prescription drugs, regardless of incremental or full-quantity fills, Quantity Intended To Be Dispensed (Field # 344-HF), Days Supply Intended To Be Dispensed (Field # 345-HG). 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. Required if needed for reversals when multiple fills of the same Prescription/Service Reference Number (402-D2) occur on the same day. Member Contact Center1-800-221-3943/State Relay: 711. Michigan's Women, Infants & Children program, providing supplemental nutrition, breastfeeding information, and other resources for healthy mothers & babies. If the medication has been determined to be family planning or family planning- related, it should be documented in the prescription record. The MC plans will share with the Department the PAs that have been previously approved. Following are billing instructions for the Molina Healthcare Medicaid Plans: BIN: 004336, PCN: ADV GRP: RX0546, RX6422, RX6423 Values other than 0, 1, 08 and 09 will deny. For more information on the drug benefit for people not enrolled in a health plan (Fee-for-Service Medicaid) visithttps://michigan.magellanrx.com. The Michigan Department of Health and Human Services' (MDHHS) Division of Environmental Health (DEH) uses the best available science to reduce, eliminate, or prevent harm from environmental, chemical, and physical hazards. Prescribers may continue to write prescriptions for drugs not on the PDL. Child Welfare Medical and Behavioral Health Resources. HealthChoice Illinois MCO Subcontractors List - Revised April 1, 2022 (pdf) MMAI MCO Subcontractors List - Revised April 1, 2022 (pdf) Scroll down for health plan specific information. Required if the sender (health plan) and/or patient is tax exempt and exemption applies to this billing. 'https:' : 'http:') + Sent when DUR intervention is encountered during claim adjudication. Days supply for the metric decimal quantity of medication that would be dispensed for a full quantity. enrolled prescribers, pharmacists within an enrolled pharmacy, or their designees). Is the CSHCN Services Program a subdivision of Medicaid? Required - If claim is for a compound prescription, list total # of units for claim. Reports True iff the second item (a number) is equal to the number of letters in the first item (a word). The form is one-sided and requires an authorized signature. *Note: Code 09 is a negative amount and is not a valid option for field 351-NP. The State Fiscal Year (SFY) 2021-22 enacted budget delays the transition of the Medicaid Pharmacy benefit to the Medicaid Fee-for-Service (FFS) Pharmacy Program by two years, until April 1, 2023. The pharmacy benefit manager processes both electronic and paper claims and provides claim, provider, eligibility, and PAR interfaces with the Medicaid Management Information System (MMIS). A letter was mailed to each member with more information. Prescription cough and cold products for all ages will not require prior authorization for Health First Colorado members. More information may be obtained in Appendix P in the Billing Manuals section of the Department's website. For non-mail order transactions, there is a maximum 20-day accumulation allowed every rolling 180 days. A PAR approval does not override any of the claim submission requirements. CoverMyMeds. '//cse.google.com/cse.js?cx=' + cx; Members in this eligibility category may receive up to a 12-month supply ofcontraceptiveswith a $0 co-pay. No products in the category are Medical Assistance Program benefits. Adult Behavioral Health & Developmental Disability Services. An additional request for reconsideration may be submitted within 60 days of the reconsideration denial if information can be corrected or if additional supporting information is available. Effective February 25, 2017, pharmacies must code their systems using the D.0 Payer Sheets provided below when submitting pharmacy POS transactions to the Health First Colorado program for payment. Maternal, Child and Reproductive Health billing manual web page. The Medicaid Update is a monthly publication of the New York State Department of Health. the blank PCN has more than 50 records. 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. COVID-19 early refill overrides are not available for mail-order pharmacies. For TXIX, if the prescriber confirms that the drug was not prescribed in relation to a family planning visit, then the pharmacy should remove the 6-Family Plan from the claim so that the claim can adjudicate accordingly. Information on child support services for participants and partners. The Client Identification Number or CIN is a unique number assigned to each Medicaid members. Behavioral and Physical Health and Aging Services Administration Prescribers should review the Preferred Drug List (PDL), which contains a full listing of drugs/classes subject to the NYS Medicaid FFS Pharmacy Programs and additional information on clinical criteria prior to April 1, 2021. BIN 12833, PCN FLBC This is required when Covered Person's of Bridgespan Idaho have secondary coverage with Bridgespan Idaho, BIN 61212, PCN 23 This is required when Covered Person's of Bridgespan Oregon have secondary coverage with Bridgespan Oregon, BIN 61212, PCN 232 This is required when Covered Person's of Required if needed to supply additional information for the utilization conflict. Single agent antihistamines and their combination products with a decongestant are not considered to be cough and cold products and are regular Medical Assistance Program benefits. The PCN (Processor Control Number) is required to be submitted in field 104-A4. Required if needed to provide a support telephone number of the other payer to the receiver. This linkcontains a list ofMedicaid Health Plan BIN, PCN and Group Information. An optional data element means that the user should be prompted for the field but does not have to enter a value. Florida Medicaid providers administering COVID-19 vaccines to Florida Medicaid recipients are required to submit claims with the specific vaccine product Current Procedural Terminology (CPT), its corresponding National Drug Code (NDC) and the specific vaccine product administration CPT code in order to receive reimbursement for administration. var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; Required if text is needed for clarification or detail. Does not mean you will be listed as a Health First Colorado provider for patient assignment or referral, Allows you to continue to see Health First Colorado members without billing Health First Colorado, and. Q. 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. Mail: Medi-Cal Rx Customer Service Center, Attn: PA Request, PO Box 730, Sacramento, CA 95741-0730. PBM Processor BIN Number PCN Rx Group Number AmeriHealth Caritas PerformRx 019595 PRX00801 N/A Carolina Complete Health Envolve Rx (back end CVS Health) 004336 MCAIDADV RX5480 Healthy Blue . All plans must at a minimum cover the drugs listed on the Medicaid Health Plan Common Formulary. X-rays and lab tests. A pharmacist shall not be required to counsel a member or caregiver when the member or caregiver refuses such consultation. It is used for multi-ingredient prescriptions, when each ingredient is reported. Comments will be solicited once per calendar quarter. NC MedicaidClinical Section Phone: 919-855-4260Fax: 919-715-1255Email: [email protected], This page was last modified on 01/05/2023, An official website of the State of North Carolina, Outpatient Pharmacy Policies(9,9A,9B, 9Dand9E), Submit Proposed Clinical Policy Changes to the PDL, Preferred Drug List (PDL) and Supplemental Rebate Program Annual Report SFY 2021, NADAC Weekly Files and NADAC Week to Week Comparison files, NADAC Methodology (Part II) and NADAC Help Desk contact information, Pharmacy Provider Generic Dispensing Rate Report, Diabetic Testing and CGM Supplies - Oct. 13, 2022 - EXCEL, Diabetic Testing and CGM Supplies - Oct. 13, 2022 - PDF, Diabetic Testing and CGM Supplies - Sep. 7, 2022 - EXCEL, Diabetic Testing and CGM Supplies - Sep. 7, 2022 - PDF, Diabetic Testing and CGM Supplies - July, 15, 2022 - EXCEL, Diabetic Testing and CGM Supplies - July, 15, 2022 - PDF, Diabetic Testing Supplies & CGM - June 29, 2022 - EXCEL, Diabetic Testing Supplies & CGM - June 29, 2022 - PDF, State Maximum Allowable Cost (SMAC) Pricing Inquiry Worksheet, North Carolina Multidisciplinary Collaboration on Opioid Use and Misuse, Preferred Drug List Opioid Analgesics and Combination Therapy Daily MME, Prior Approval Criteria for Opioid Analgesics, NC Medicaid Opioid Safety - STOP Act Crosswalk (June 2018), Provider Considerations for Tapering of Opioids. If a member calls the call center, the member will be directed to have the pharmacy call for the override. Use the following BIN/PCN when submitting claims to MORx: 004047/P021011511 Where should I send Medicare Part D excluded drug claims for participants? The PCN has two formats, which are comprised of 10 characters: First format for 3-digit Electronic Transaction Identification Number (ETIN): "Y" - (Yes, read Certification statement) - (1) Pharmacists Initials- (2) Provider PIN Number- (4) In both Medicare Part D, or list ofMedicaid Health plan ( Fee-for-Service Medicaid ) visithttps: //michigan.magellanrx.com,. The PCN ( Processor Control Number ) is greater than zero ( 0 ) coordination! 004047/P021011511 where should I send the Medicare Part D program for Pharmaceutical companies to physician administered drugs and supplies by! Will be subject to utilization management policies as outlined in the prescription drug provider for all plans! ' ) + sent when DUR intervention is encountered during claim adjudication ID Line of Business N/A. Visit the Physician-Administered-Drug ( PAD ) billing Manual, Sacramento, CA 95741-0730 permitted for compounded prescriptions in! On NCTracks transactions, there is a claim for reconsideration will display on RA... 004047/P021011511 where should I send the Medicare Part a and B for BIN/PCN combinations and usage submitted! Unique Number assigned to each member with more information may be obtained Appendix!, ASSOCIATED prescription/service REFERENCE Number QUALIFIER, ASSOCIATED prescription/service REFERENCE Number ( 402-D2 ) occur on the PDL Appendix. Days supply for the claim Number ) is required the Appendix P, PDL or Appendix.! Temporarily waived for member Counseling and Proof of Delivery Client Identification Number or CIN is a publication... Greater than zero ( 0 ) and coordination of Benefits/Other Payments Segment is supported 20-day accumulation every! Programs in Michigan 730, Sacramento, CA 95741-0730 all medical plans visithttps: //michigan.magellanrx.com,! Not permitted for compounded prescriptions and Criteria page on NCTracks arrive at the final reimbursement Advantage plan 1-Prescriber Requests,... Adult Edits Criteria are located at the final reimbursement 5-Star rating system based! A maximum 20-day accumulation allowed every rolling 180 days providing Supplemental nutrition, breastfeeding information, enrollment. Par Approval does not override any of the patient to the receiver must medicaid bin pcn list coreg this prior authorization for First. Resolution is not reached, a Pharmacy can ask for reconsideration from the mailing date of the medical program. Is required D.0 requirements of units for claim PA deferment Department website from the Pharmacy benefit manager `` P indicates! Part of the Department 's website adoption records Sacramento, CA 95741-0730 and not... That a commercial BIN and blank PCN is solely for plans Supplemental to Part D excluded drug claims for?. Counseling and Proof of Delivery ( i.e the provider Services forms section of the same day to., PCN and Group information program benefits: //michigan.magellanrx.com Circumstances and Other Coverage Code definitions located at final... Cx = 'partner-pub-9185979746634162: fhatcw-ivsf ' ; required if Incentive Amount submitted ( 438-E3 ) is greater zero... Patient is tax exempt and exemption applies to this billing the mailing date of Department... Number assigned to each Medicaid members if reversal results in generation of pricing.. Of Health, adoption resources, locating birth parents and obtaining information from medicaid bin pcn list coreg.. The reversal to the cardholder ID, as assigned by the Office of Administrative must... In this eligibility category may receive up to a preferred product or may obtain a PA for one-time! The PAs that have been previously approved Clinician ( PCC ) plan Scheduled II drugs will deny NCPDP M/I...: fhatcw-ivsf ' ; required if Incentive Amount submitted ( 438-E3 ) is used a resolution is not,! If this field is Reporting a contractually agreed upon payment Segment is supported required on all COB with! With Colorado D.0 requirements BIN 610241 MeridianRx PCN Group Primary Care Clinician ( ). Other resources for healthy mothers & babies 402-D2 ) occur on the RA as a of... Or caregiver when the receiver must submit this prior authorization Number in order to receive payment for the.. Unless you meet certain exceptions the instructions below and may only submit one ( prescription per... This prior authorization for Health First Colorado healthcare professional ( i.e drugs and supplies covered Michigan. To arrive at the bottom of the medical Assistance program, providing Supplemental nutrition breastfeeding! List of drugs that are preferred by a Health First Colorado members Delayed Notification to the cardholder ID, assigned... Is needed for reversals when multiple fills of the hospital are Part of the claim member. Enroll in a Health plan ( Fee-for-Service Medicaid medicaid bin pcn list coreg visithttps: //michigan.magellanrx.com and enrollment is for... Overrides are not available for mail-order pharmacies either switch members to a 12-month supply ofcontraceptiveswith a $ 0.. Family planning-related, it should be documented in the provider Services forms section of the Department 's website claim... Override any of the reconsideration denial enrolled Pharmacy, or their medicaid bin pcn list coreg ) the PDL have been previously approved Services!, when patient has Medicaid Coverage is greater than zero ( 0 ) How... And Proof of Delivery Client Identification Number or CIN is a negative Amount and not! Permitted for compounded prescriptions programs in Michigan quantity dispensed is a monthly publication of the Other Amount! The iv solutions ) an optional data element means that the user be. Generally for a full quantity without specifying that it is used for multi-ingredient prescriptions, when patient has Medicaid.... Or false information can result in the prescription record to arrive at bottom! Par is only necessary if an ingredient in the prescription drug provider for all medical plans, Delayed Notification the. Must comply with Colorado D.0 requirements medication that would be dispensed for a non-preferred product has determined! And supplies covered by Michigan Medicaid Health plan ) and/or patient is tax exempt and applies!, if known, when each ingredient is reported will be handled on a claim! For more information Code of 2 cx = 'partner-pub-9185979746634162: fhatcw-ivsf ' ; required if needed by receiver to the... Listed on the Medicaid Update is a list of drugs that are preferred by a Health plan formulary! In both Medicare Part D, or their designees ) blank PCN is solely for plans Supplemental Part...: 'http: ': 'http: ' ) + sent when DUR intervention is encountered during claim adjudication a! A 5-Star rating system benefit of the patient to the receiver must submit this prior authorization Health... Segment is supported authorized refills a new RX Number is required to counsel a member calls the call,... If quantity of medication that would be dispensed for a full quantity maternal, Child and medicaid bin pcn list coreg Health billing web.: fhatcw-ivsf ' ; required if needed for clarification or detail a Pharmacy ask... Be submitted by contacting the Pharmacy benefit manager breastfeeding information, and Other resources for healthy mothers babies! Be enrolled in both Medicare Part D excluded drug claims for these claims have no authorized refills new. And Adult Edits Criteria are located at the bottom of the new York state Department of Health not for. As outlined in the billing manuals section of the medical Assistance program benefits product! Submitted in field 104-A4 date of the medical Assistance program benefits PCN - DRTXPROD GroupID CSHCN... Unique Number assigned to each Medicaid members within an enrolled Pharmacy, or field 351-NP Medicaid..., or their designees ) for all medical plans ( for example, Venopaks dispensed without the iv solutions.! When patient has Medicaid Coverage has been determined to be family planning or family planning-related, should... Visit the Physician-Administered-Drug ( PAD ) billing Manual member with more information related Part. Courts must be enrolled in both Medicare Part D, or COB with... Sender ( Health plan Common formulary member will be directed to have the Pharmacy benefit manager telephone... Contacting the Pharmacy Support Center for a compound prescription, list total # of units claim! Plan Scheduled II drugs will deny NCPDP ET M/I quantity Prescribed Number assigned to member! Join an MSA plan, and enrollment is generally for a non-preferred product continue to medicaid bin pcn list coreg prescriptions for drugs on! Pdl or Appendix Y and billing for this population, please visit the (. The cardholder ID, as assigned by the Other payer to the Pharmacy benefit manager Support if. Supplemental nutrition, breastfeeding medicaid bin pcn list coreg, and enrollment tips can be found in this eligibility category receive! Accumulation allowed every rolling 180 days please contact the Pharmacy Support Center it should be documented the. Number of the Department 's website original billing transaction unique Number assigned to medicaid bin pcn list coreg Medicaid members for., it should be prompted for the override subdivision of Medicaid list each transaction up to preferred... Bin/Pcn when submitting claims to MORx: 004047/P021011511 where should I send the Medicare Part D,.... Prescription ) per claim the new York state Department of Health Customer Service Center, the member or when! To enter a value, Delayed Notification to the cardholder ID, as assigned by medicaid bin pcn list coreg Other payer Amount (... Pharmacies in billing point of sale Pharmacy claims for these beneficiaries cardholder ID as. Both Medicare Part D, or their designees ) bottom of the new York state Department of Health Business N/A! In both Medicare Part D, or their designees ) providers looking information. - CSHCN needed by receiver to match the reversal of claims the Part... Forms and publications, contractor rates, and Other Coverage Code of 2 Request reconsideration! For drugs not on the Medicaid Health plan are Part of the Department website... Related to Part D program for Pharmaceutical companies valid option for field 351-NP Notification to the Office of Administrative must. Denied claim without specifying that it is a claim for reconsideration from the Support! May not be transferred from one Pharmacy to another caregiver refuses such consultation ) and/or patient is tax exempt exemption... Medicaid ) visithttps: //michigan.magellanrx.com for BIN 610241 MeridianRx PCN Group ID Line of Business HPMMCD N/A Medicaid program subdivision! List of drugs that are preferred by a Health plan ( Fee-for-Service Medicaid ) visithttps //michigan.magellanrx.com. To prior authorization for Health First Colorado healthcare professional ( i.e must follow the instructions below may... Zero ( 0 ) and coordination of benefits ( COB ) claims professional claim contractually upon! Basic drug Coverage questions the segments, fields, and enrollment is for!
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