To: Pharmacy Providers
From: Bruce McClenahan, Pharmacy Unit Manager
Date: January 4, 2008
Re: Part D Information
The new Medicare Part D enrollments for 2008 are now active. Many members now have new plans and many plans have made changes, below are some of the changes we are aware of.
Multiple PDP’s have moved people from one plan to another plan to remain under the benchmark premium of $30.64 for 2008. With that change, the members may have new cards with different PCN, BIN and Group #’s affecting how you process the claims or leading to rejections at the store level.
For example: Unicare (standard plan) - GRP# 180033D004
BIN# 610575
PCN# 7700630
Please verify card information with the members or call the PDP if you encounter this problem with a particular plan. You may contact the GHS Pharmacy Helpdesk at 1-888-420-9711 if you have any questions and for additional assistance the OMS help desk is available with extended hours if you have questions regarding plans. You may call from 8am – 7pm Monday through Friday and 8am until noon on Saturday, the number is 1-866-796-2463.
Fox Insurance Company has changed their PBM from Caremark to Envision. The plan information was supplied in the 12/15/07 newsletter, again, that information is: Group# for Value Plan S5557002 Group # for Grand Plan S5557007, BIN for both plans is 012312, and PCN for both plans is PARTD. For pharmacies that are not a member of this PBM you can call the Envision pharmacy helpdesk at 1-866-417-3073 to become a provider.
Part B and D Combo claims.
The State of Maine would like to remind Providers that when submitting PartB/D Combo claims that the EOB must be included with the Combo paper claim form for processing. If the EOB is not attached then the claim will be sent back to the store. The State would also like to remind providers that when the State pays secondary on the Combo claim, we pay the Medicare allowable rate not the usual and customary rate. Please find a copy of the PartB/D combo claim at www.mainecarepdl.org or contact the GHS helpdesk at or call 1-888-420-9711 if you have any questions.