10181 Scripps Gateway Court, San Diego, CA 92131
Date: May 13, 2016
To:Third Party/Pharmacy
From:Pharmacy Network ManagementPhone:(800) 788-2949
MedImpact Healthcare Systems
Subject: County Medical Services Program – Primary Care Benefit
MedImpact Healthcare Systems, Inc. began processing for County Medical Services Program’s Primary Care Benefit (PCB)as of May 1, 2016.
CMSPAid Code 50 (undocumented) and Aid Code 89 (legal resident) Members with beginning dates of aid on or after May 1, 2016 qualify for the CMSP Primary Care Benefit (PCB).
Members will be provided a separate ID card with a separate ID number that is different than the CMSP Standard Benefit ID.
Prescriptions must be provided during the PCB benefit eligibility period dates printed on the card. This benefit will not pay for prescriptions provided outside of the PCB benefit period.
Prescription drugs listed on the Primary Care Benefit drug formulary are a PCB covered benefit with a $5.00 copay per prescription (up to a maximum of $1500 in prescription drug benefits per PCB eligibility period).
The CMSP Primary Care Benefit ID Card provides information on how to contact MedImpact regarding claiming for this benefit.
Since you have already agreed to participate with MedImpact, there will be no information for you to return. Enclosed please find the following information to assist you in processing claims:
- Sample ID Card(s)
- Profile Sheet
If you have any questions, please feel free to contact our Pharmacy Help Desk at 800-788-2949.
PLAN PROFILE SHEET
Plan Name / County Medical Services Program’s Primary Care BenefitNumber of Lives / TBD / Location / California
Plan Type / Commercial Medicaid Medicare Cash Discount Card
Effective Date / 05/01/2016
RX BIN / 003585
RX PCN / 50145
RX Group / 50145
Person Code / Not Required
Incumbent Processor / MedImpact Healthcare Systems, Inc.
Sample ID Card(s) / Attached
Retail / Max Day Supply: 30
Mail Order / Max Day Supply: NA
Choice90 / Max Day Supply: NA
Member Reimbursement / MedImpact Plan Does Not Apply
Prior Authorizations / MedImpact Plan Does Not Apply
Date of Birth Validation / Yes / Twin/Triplet Validation / Patient First Name
Prescriber Id / NPI
eCOB Method / No eCOB
Proprietary and Confidential
The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without prior authorization.