})(); Chart of 2022 BIN and PCN values for each Medicare Part D prescription drug plan Part 4 of 6 (H5337 through H7322). The situations designated have qualifications for usage ("Required if x", "Not required if y"). The following lists the segments and fields in a Claim Billing or Claim Rebill Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0. We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. The Health First Colorado program restricts or excludes coverage for some drug categories. The physician is of an opinion that a transition to the generic equivalent of a brand-name drug would be unacceptably disruptive to the patient's stabilized drug regimen and criteria is met for medication. Instructions for checking enrollment status, and enrollment tips can be found in this article. Required if needed to uniquely identify the family members within the Cardholder ID, as assigned by the other payer. PCN List for BIN 610241 MeridianRx PCN Group ID Line of Business HPMMCD N/A Medicaid . Prescription cough and cold products for all ages will not require prior authorization for Health First Colorado members. Required on all COB claims with Other Coverage Code of 2 or 4 - Required if Other Payer Amount Paid Qualifier (342-HC) is used. 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 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. No products in the category are Medical Assistance Program benefits. Vision and hearing care. For DAW 8-generic not available in marketplace or DAW 9-plan prefers brand product, refer to the Colorado Pharmacy Billing Manual, Substitution Allowed - Patient Requested Product Dispensed. Required if needed to match the reversal to the original billing transaction. Instructions for checking enrollment status, and enrollment tips can be found in this article. Plan Name PBM Name BIN PCN Group AETNA CVS Health 610591 ADV RX8834 AMERIGROUP Express Scripts 003858 MA WKLA AMERIHEALTH CARITAS LA PerformRx 600428 06030000 n/a . Contact Pharmacy Administration at (573) 751-6963. Group: ACULA. Copies of all forms necessary for submitting claims are also available on the Pharmacy Resources web page of the Department's website. All questions regarding the Pharmacy Carve-Out should be emailed to, Providers interested in receiving MRT email alerts, visit the. Pharmacy Help Desk Contact Information AmeriHealth Caritas: 866-885-1406 Carolina Complete Health: 833-992-2785 Healthy Blue: 833-434-1212 United Healthcare: 855-258-1593 WellCare: 866-799-5318, option 3 The BIN is on the SPAP / ADAP table with a blank PCN and the BIN is unique to the SPAP / ADAP, or. If the medication has been determined to be family planning or family planning- related, it should be documented in the prescription record. Medicare evaluates plans based on a 5-Star rating system. the blank PCN has more than 50 records. Pharmacies may request an early refill override for reasons related to COVID-19 by contacting the Pharmacy Support Center. Scroll down for health plan specific information. Providers submitting claims using the current BIN and PCN will receive the error messages listed below. Information on resources in your community and volunteer recruitment and training, and services provided at local DHS offices. var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; Bureau of Medicaid Care Management & Customer Service Required - If claim is for a compound prescription, enter "0. COVID-19 early refill overrides are not available for mail-order pharmacies. Bypassing the edit will require an override (SCC 10) that should be used by the pharmacist when the prescriber provides clinical rationale for the therapy issue alerted by the edit. A member has tried the generic equivalent but is unable to continue treatment on the generic drug and criteria is met for medication. There is no registry of PCNs. ", 00 = If claim is a multi-ingredient compound transaction, Required - If claim is for a compound prescription, enter "00.". This form or a prior authorization used by a health plan may be used. Required if other payer has approved payment for some/all of the billing. Information about the Michigan law that requires certain information be made available to a woman who is seeking an abortion at least 24 hours prior to the abortion procedure. Required if Other Payer patient Responsibility Amount (352-NQ) is submitted. Updates made throughout related to the POS implementation under Magellan Rx Management. If you cannot afford child care, payment assistance is available. Product may require PAR based on brand-name coverage. Required if Other Payer ID (340-7C) is used. Birth, Death, Marriage and Divorce Records. Interactive claim submission must comply with Colorado D.0 Requirements. Required when additional text is needed for clarification or detail. All plans must at a minimum cover the drugs listed on the Medicaid Health Plan Common Formulary. A compounded prescription (a prescription where two or more ingredients are combined to achieve a desired therapeutic effect) must be submitted on the same claim. Completed PA forms should be sent to (800)2682990 . Effective 10/22/2021, Corrected formatting error; replaced "" with numeric "0", Added Real Time Prior Authorization via EHR to PAR Process, Updated to reflect billing changes to family planning and family planning-related services, Updated family planning-related section for clarity, Added primary insurance clarification to PAR Process and max day supply clarification to Dispensing Requirements, Added record maintenance requirements under Counseling, Retention of Records, and Signature Requirements, Removed requirement for providers to obtain a new override each fill for TPL/COB prior authorizations, Updated qualifier codes accepted in COB/ Other Payments under Claim Billing, Proposed rendering provider (if identified on the PAR), Non-preferred agents subject to the Preferred Drug List (PDL), Preferred agents with clinical criteria attached to the medication and all non-preferred agents subject to the Preferred Drug List (PDL) Over-the-counter (OTC) drugs that are not a regular Health First Colorado program benefit, Intravenous (IV) solutions with clinical criteria attached to the medication, Total Parenteral Nutrition (TPN) therapy and drugs, Significance of impact on the health of the Health First Colorado program population, Required monitoring of prescribing protocols to protect both the long-term efficacy of the drug and the public health, Potential for, or a history of, drug diversion and other illegal utilization, Appearance of the Health First Colorado program usage in amounts inconsistent with non- medical assistance program usage patterns, after adjusting for population characteristics, Clinical safety and efficacy compared to other drugs in that class of medications, Availability of more cost-effective comparable alternatives, Procedures where inappropriate utilization has been reported in medical literature, Performing auditing services with constant review on drug utilization. 02 = Amount Attributed to Product Selection/Brand Drug (134-UK) For more information related to physician administered drugs and billing for this population, please visit the Physician-Administered-Drug (PAD) Billing Manual. Please Note: Incremental and subsequent fills are not permitted for compounded prescriptions. Required for partial fills. The benefit information provided is a brief summary, not a complete description of benefits. What is the Missouri Rx Plan (MORx) BIN/PCN? Claims submitted with the Prescriber State License after 02/25/2017 will deny NCPDP EC 25 - Missing/Invalid Prescriber ID. Harvard Pilgrim Health Care of New England, Inc. Everyone in your household can use the same card, including your pets. Please resubmit with appropriate DAW code: 1-prescriber requests brand, contact MRx at 18004245725 for override. Members previously enrolled in PCN were automatically enrolled in Medicaid. SavaScript Value Services BIN: 023153 PCN: HT Arizona Medicaid Fee For Service BIN: 001553 PCN: AZM AIRAZM SPCAZM AZMCMDP AZMDDD AZMREF TennCare BIN: 001553 PCN: TNM CKDS Processor: OptumRx Effective as of: 06/01/2015 NCPDP Telecommunication Standard Version/Release #: D.0 NCPDP Data Dictionary Version Date: October 2017 NCPDP External Code . Certain restricted drugs require prior authorization before they are covered as a benefit of the medical assistance program. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. Required if needed to identify the transaction. Added Temporary COVID section, updated Provider Web Portal link, Updated verbiage to include the NCPDP D.0 guidelines for field 460-ET, Updated DAW Codes: Updated Dispense as Written (DAW) Override Code table. Sent when claim adjudication outcome requires subsequent PA number for payment. The provider creates interactive claims one at a time and transmits them by toll-free telephone through a switch company to the pharmacy benefit manager. The following lists the segments and fields in a Claim Billing or Claim Rebill response (Paid or Duplicate of Paid) Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0. Approval of a PAR does not guarantee payment. Information on the Safe Delivery Program, laws, and publications. Prior Authorization Request (PAR) Process, Guidelines Used by the Department for Determining PAR Criteria, Incremental Fills and/or Prescription Splitting, Lost/Stolen/Damaged/Vacation Prescriptions, Temporary COVID-19 Policy and Billing Changes, Medication Prior Authorization Deferments, EUA COVID-19 Antivirals Claim Requirements, Ordering, Prescribing or Referring (OPR) Providers, Delayed Notification to the Pharmacy of Eligibility, Instructions for Completing the Pharmacy Claim Form, Response Claim Billing/Claim Rebill Payer Sheet Template, Claim Billing/Claim Rebill Accepted/Paid (or Duplicate of Paid) Response, Claim Billing/Claim Rebill PAID (or Duplicate of PAID) Response, Claim Billing/Claim Rebill Accepted/Rejected Response, Claim Billing/Claim Rebill Rejected/Rejected Response, NCPDP Version D.0 Claim Reversal Template, Request Claim Reversal Payer Sheet Template, Response Claim Reversal Payer Sheet Template, Claim Reversal Accepted/Approved Response, Claim Reversal Accepted/Rejected Response, Claim Reversal Rejected/Rejected Response, Pharmacy Prior Authorization Policies section. Mental illness as defined in C.R.S 10-16-104 (5.5). The replacement request and verification must be submitted to the Department within 60 days of the last refill of the medication. The PCN (Processor Control Number) is required to be submitted in field 104-A4. Claims that cannot be submitted through the vendor must be submitted on paper. The chart below is the first page of the 2022 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts E0654 through H1997. 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. Drugs produced by companies that have signed a rebate agreement (participating companies) are generally a Health First Colorado program benefit but may be subject to restrictions. MeridianRx 2017 Payer Sheet v1 (Revised 11/1/2016) Claims Billing Transaction . The Department does not pay for early refills when needed for a vacation supply. 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 2505-10 Volume 8) for further guidance regarding benefits and billing requirements. MassHealth PBM BIN PCN Group Primary Care Clinician (PCC) Plan For 8-generic not available in marketplace, 9-plan prefers brand product, or refer to the Colorado Pharmacy Billing Manual. The North Carolina Medicaid Pharmacy Program offers a comprehensive prescription drug benefit, ensuring low-income North Carolinians have access to the medicine they need. Michigan's Women, Infants & Children program, providing supplemental nutrition, breastfeeding information, and other resources for healthy mothers & babies. Required when the patient meets the plan-funded assistance criteria, to reduce Patient Pay Amount (505-F5). 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. money from Medicare into the account. Box 30479 The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2022 Medicare Part D plan sponsor. The Client Identification Number or CIN is a unique number assigned to each Medicaid members. More information may be obtained in Appendix P in the Billing Manuals section of the Department's website. Commissioner PCN Phone Fax Email HPMMCD (Medicaid) 866-984-6462 877-355-8070 info@meridianrx.com . Metric decimal quantity of medication that would be dispensed for a full quantity. 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