1. 2 provider information changes in pharmacy billing procedures website information call center...
TRANSCRIPT
1
2
Provider Information
• Changes in Pharmacy Billing Procedures
• Website Information• Call Center • Prior Authorization Information• Contact Information• Questions and Answers
3
Changes / Reminders in Billing Procedures
•All MAA Pharmacy Claims must be submitted to ACS’ PDCSX2 system beginning June 29, 2008 at noon.
•Multi-Line Compounds will be accepted via Point of Sale (POS)
•Providers must enter a code in the Prescription Origin Code field beginning on June 29, 2008.
•New mailing address for paper claims
•New phone and fax numbers for the technical and clinical call center
4
Changes to Paper Claims
Starting June 25, 2008 paper claims must be submitted to the following address:
ACSPO Box 967Henderson, NC 27536Attn: Paper Claims
5
Changes to the POS Format
BIN Number will change to 610084
Group ID is still required DCMEDICAID
Processor Control Number will now beDRDCACCP (Test Region)DRDCPROD (Production Region)
6
Coordination of Benefits (COB)
• The District of Columbia is the payer of last resort.
• All pharmacy claims submitted will be edited for the presence of other insurance.
• A provider will receive an NCPDP edit ’41’ if there is presence of other payers on the eligibility file and there is no indication on the claim that it has been sent to the primary payer (s).
• When an edit ’41’ is returned, on the response the provider will also receive the other carrier ID and policy number if provided.
7
Coordination of Benefits (COB)
•Pharmacy providers are required to submit to the primary payer first then bill the District for any remaining amount.
•Refer to the MAA District PBM Payer sheet for instructions on how to bill the District as payer of last resort.
•The payer sheet is available on the District web site and in your packet of information supplied today.
8
Multi-Line Compounds
Beginning June 29, 2008, Multi-line compounds will be accepted at Point of Sale (POS). The following fields are required when submitting a multi-line compound:
Fields:
308-C8 (Compound Code) = 2
450-EF (Compound Dosage Form Description Code)
451-EG (Compound Dispensing Unit Form Indicator)
452-EH (Compound Route of Administration)
447-EC (Compound Ingredient Component)
488-RE (Compound Product ID Qualifier)
489-TE (Compound Product ID)
448-ED (Compound Ingredient Quantity)
9
Prescription Origin Code
In order to satisfy the Tamper Proof Prescription Pad legislation, the Prescription Origin Code field is now required on all DC MAA Pharmacy claims submitted.
The following are the valid values accepted:
0 = Not Specified
1 = Written
2 = Telephone
3 = Electronic
4 = Facsimile
10
ProDUR Edits
The following edit will be a hard denial and require a Prior Authorization to be received before a claim will be paid.
Refill Too Soon will post NCPDP reject 79
The following ProDUR alerts will deny but POS overrides are allowed:
Therapeutic Duplication (TD)Drug-Drug Interaction (DD)Drug-Age Interaction (PA)Drug-Gender (SX)Overuse (ER)High Dose (HD)Drug Pregnancy (PG)High Cost (HC)
All other ProDUR edits will be bypassed at POS.
11
MAA Pharmacy Program Copay
•Copay amounts for MAA Pharmacy claims are $1.00 for any recipient over the age of 21.
•The following are exempt from the copay rule above:
•Recipients under the age of 21
•LTC recipients
•Pregnant
13
DC MAA Website
DC Medical Assistance Administration
14
DC MAA Website
DC Medical Assistance Administration
15
DC MAA Website
DC Medical Assistance Administration
16
Call Center and Prior Authorization
ACS Call Center Information
ACS / District POS Help Desk (available 24/7)
1-800-272-9679ACS Clinical Call Center – Prior Authorizations
Phone - 1-800-273-4962
Fax - 1-866-535-7622
17
District Medical Assistance AdministrationPharmacy Program:Carolyn Rachel-Price, [email protected]
ACS Contact Information
Provider Relations:[email protected] and use the contact us link
Contact Information
18
DC MAA Provider Testing
In order to submit a test claim to ACS you must do one of the following:
Send an email to ACS at [email protected] and include a contact name, the pharmacy name, address, phone number and email address and in the title line put DCTC (DC Test Claims). The testing material will be sent to you by email.
If you do not have an email account, please call1-866-322-5960 ext 8536 and leave a contact name, fax number and advise that you are with The District.
19
Commonly Asked Questions
Below are some questions and answers commonly asked at the time of PBM Transition:
1. What is the new PCN and BIN?
BIN = 610084
PCN = DRDCPROD
2. What time will the current processor stop processing claims?
The current vendor First Health will cease claims processing at 10:00pm on Saturday, June 28, 2008.
20
Commonly Asked Questions, cont’d
3. When will ACS begin processing claims?
ACS will begin processing claims no later than 12:00 noon on June 29, 2008.
4. What is the website address?
www.dcpbm.com
5. When should we begin to mail paper claims to ACS?
Paper claims should be sent to ACS beginning June 25, 2008.
21
Commonly Asked Questions, cont’d
6. What happens if we mistakenly send paper claims to the current vendor after June 25, 2008?
The current vendor will fax paper claims received after June 25, 2008.
22
Questions