October 30, 2018
Caremark: Transaction Submission Service Fees
Beginning January 1, 2016, CVS/Caremark implemented the Transaction Submission Resolution Management Service Fee (TSRMSF) for Medicare Part D. The transaction fees are not being charged as of yet. There will be an initial lump sum offset to your regular pharmacy payment in April 2016. This lump sum will cover transactions submitted between January 1, 2016 and March 31, 2016. In May of 2016, and each subsequent month, Caremark will capture the transactions submitted during the previous month. The TSRMSF will be collected in a lump sum offset to your regular payment. The maximum overall transaction submission fee will be $0.15 per claim.
Aetna: Coventry Health Care/First Health
As a reminder, at the beginning of the year, Coventry Health Care/First Health has new claims processing information for Medicare Part D members. They advised pharmacies to proactively update member profiles with the updated information now. This will prevent disruption at the point of sale beginning April 1, 2016. Claims that are not submitted with the new information listed below will receive a rejection with the following message: Reject 06: <Missing/Invalid Group ID>.
Rx BIN: / 610502Rx PCN: / MEDDAET
Rx Group: / RXAETD
Prime Therapeutics: Florida Blue
Beginning April 1, 2016, Florida Blue will implement a new Opioid Misuse Concurrent Drug Utilization Review (CDUR) program. This program’s goal is to provide pharmacies with critical information related to covered persons who are engaged in the following: Using a high dose of opioids based on cumulative claim history, received recent opioid prescriptions from 3 different prescribing providers, and have attempted to fill 3 recent opioid prescriptions from 3 different pharmacies. Pharmacists should use their best judgement to determine how to proceed when presented with this information.
Caremark: Molina Healthcare of Ohio
Effective now, a small group of members from Molina Healthcare of Ohio are moving to RXGRP. Members will receive new cards with updated claims processing information. Please update or create plan member profiles as appropriate.
Rx Bin: / 004336Rx PCN: / MCAIDOH
Rx Group: / RX0718
Member ID Format: / 12 Digits
Person Code: / 001
U.S. Script: Ambetter from Superior HealthPlan Claims
Pharmacies are contractually obligated to process claims for members of Ambetter from Superior Healthplan. These claims should be processed using BIN 008019. A PCN is not needed in order to process these claims.
Argus: Gateway Medi-Span Price Source Update
Argus has moved customers with the BIN/PCN combination listed below to their new Medi-Span AWP based networks. Argus has noticed that a small number of NDCs (mostly OTC products) are not pricing with Medi-Span because they are not listed on their file. If this is the case you will see a NCPDP reject 54 “Non-matched Product/Service ID number”. They suggest if you receive this rejection to try the UPC code on the product. This code may have been listed as the primary ID instead of the NDC code. If this is unsuccessful as well, Argus recommends dispensing a comparable product with a different NDC code.
Commercial BIN / 600428Commercial PCN / 02710000
Medicare Part D BIN / 012353
Medicare Part D PCN / 03740000
Express Scripts: Consolidated Nuclear Security
Some members of consolidated Nuclear Security LLC are changing benefit groups effective immediately. Members will receive new ID cards with their new Rx Group. The member ID is not changing. Process claims for these members using the following information:
BIN / 610014PCN / Not required
Rx Group / As shown on member ID card
Caremark: Target
Effective April 1, 2016, Caremark will administer the prescription benefits for Target. Please update or create member profiles to reflect the changes for this new plan.
Rx BIN / 004336Rx PCN / ADV
Rx Group / RX0147
Member ID Format / 11 digits
Person Code / 2 digits
The following vaccines will be covered for members with this plan: seasonal influenza (Trivalent, Quadrivalent, Intranasal, Instradermal, and HD), adult & pediatric preventative care vaccines, including, but not limited to, Pneumonia, Hepatitus A & B, Tetanus, HPV, Varicella, MMR, and TDP.
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