May 13, 2016
Caremark: Reminder – Transaction Fees
As previously communicated, Caremark implemented Transaction Submission Resolution Management Service Fees (TSRMSF) for Medicare Part D claims. Beginning in May pharmacies will begin to see the TSRMSF on their remittance advises. The lump sum offset for this month will cover claims submitted between January 1, 2016 and April 30, 2016. The May remittance advice will contain several months of claims, therefore there may be several rows of fees, depending on the pharmacy’s claim activity. Beginning June 2016, and each subsequent month, Caremark will capture the transactions submitted during the previous month and collect the fee as a lump sum offset to your regular pharmacy payment.
Texas Medicaid Providers
As previously communicated, all Texas Medicaid providers are required to re-enroll in Texas Medicaid. The deadline for pharmacies who have not already done so has been extended to June 17, 2017. If a final approval on the application is not received before September 24, 2016 then the provider will be removed from Texas Medicaid and not receive reimbursement. For more information about re-enrollment, including the pharmacy application and agreement, go to: TxVendorDrug.com/providers/enrollment-forms
Prime Therapeutics: New Plan
Effective May 1, 2016 Prime Therapeutics will begin processing claims for IMA, Inc. Please use the following information to set up your system in order to ensure uninterrupted service: BIN 610455 PCN IMAINC, covered person ID number (1 alpha, 8 numeric).
Caremark: New York MetroPlus Medicare Advantage
Per New York state regulation, a provider of a Medicare Part B benefit cannot seek to recover any Medicare Part B deductible or co-insurance amounts from Medicare-Medicaid dual eligible individuals. Pharmacies cannot require MetroPlus Advantage Members with full Medicaid to pay for diabetic supplies. Covered members with full Medicaid will receive a letter that they should receive their diabetic supplies at no charge.
U.S. Script: Network Transition for BIN 008019
Effective May 13, 2016, U.S. Script will begin utilizing Caremark’s provider agreements for the following plans: Bridgeway Health Solutions, Enpatico Integrated Care and California Health & Wellness. This includes Caremark’s pharmacy networks and reimbursement terms. Retail claims impacted by this transition will continue to process through U.S. Script. Payment processing rules and payment cycles will continue to appear as U.S. Script on electronic or paper remittances. The reimbursement calculation will be the lesser of: AWP Discount plus Dispensing Fee or MAC plus Dispensing Fee or U & C. This transition does not apply to following U.S. Script networks: Extended Day Supply, 340B, Specialty, Compound and Vaccine.
Catamaran: Nevada AIDs Drug Assistance Program
Effective immediately, claims for covered persons for Nevada AIDs Drug Assistance Program should be submitted using the following information: Group- NVCOB, BIN- 005947, PCN- MEDDTROOP, Member ID Format- 9 digit base ID with 2 digit person code. Claims need to be submitted to the member’s primary insurance and then Nevada AIDs as a secondary with OCC 8. Once the claim has been submitted to Nevada AIDs as the secondary, the member’s co-pay will be zero.
Express Scripts: Anthem BCBS Medicaid Half Tablet Program
The Half Tablet Program has pharmacies dispense fewer tablets while maintaining the same days’ supply. The targeted drugs are being taken once a day, and have been clinically reviewed to confirm that pill splitting will not reduce patient compliance or efficacy of the medication. Effective June 1, 2016, Anthem Blue Cross and Blue Shield Medicaid (Anthem) will implement this program. Drug categories include Antipsychotics/Antimanic agents and Antihyperlipdemics. Pharmacies will be required to stock and dispense up to two of the below NDCs annually for all Anthem prescriptions containing pill splitting instructions. Pill splitters require a prescription from the physician.
NDC / FDB Brand Name / FDB Manufacturer25715067767 / Deluxe Table Cutter / Apothecary Prod
25715067830 / Tablet Cutter / Apothecary Prod
25715067015 / Tablet Cutter / Apothecary Prod
49022007425 / Deluxe Cut N Crush / Walgreen Co
11917005315 / Deluxe Safety Tablet Cutter / Walgreen Co
40986001651 / Safety Tablet Cutter / Chain Drug Cons
11822377360 / Tablet Cutter / Rite Aid Corp
11917006411 / Safety Shield Table Cutter / Walgreen Co
NCPDP: Pharmacy Profile Update
NCPDP will be performing an audit of their database in the coming months. Any profiles that are no longer current will be deactivated. To keep your NCPDP number active it is required the pharmacy review and verify the pharmacy’s profile for accuracy at least twice a year. If a pharmacy profile is deactivated the pharmacy will incur a $275 charge to reactivate.
TriNet recommends our members to log in as soon as possible (https://accessonline.ncpdp.org) and review the pharmacy’s profile. Be sure all licenses (state and DEA), hours of operations, taxonomy codes, and contact information are up to date. If you need the log in information please email NCPDP at .
Please also report any demographic, staff, and/or license changes to TriNet by email or or call 800.333.8097.
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