Billing questions should be directed to (800)3439000. Information about the health care programs available through Medicaid and how to qualify. The Michigan Domestic & Sexual Violence Prevention and Treatment Board administers state and federal funding for domestic violence shelters and advocacy services, develops and recommends policy, and develops and provides technical assistance and training. Pharmacies can also check a member's enrollment with a West Virginia Medicaid MCO by calling 888-483-0793 Copies of all forms necessary for submitting claims are also available on the Pharmacy Resources web page of the Department's website. Behavioral and Physical Health and Aging Services Administration Clinical concerns or PDP questions should be directed to (877)3099493 or visit the. October 3, 2022 Stakeholder Meeting Presentation. Quantity Prescribed (Field # 460-ET) for ALL DEA Schedule II prescription drugs, regardless of incremental or full-quantity fills, Quantity Intended To Be Dispensed (Field # 344-HF), Days Supply Intended To Be Dispensed (Field # 345-HG). A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Required when needed to communicate DUR information. Required if Other Payer Amount Paid (431-Dv) is used. Claims that do not result in the Health First Colorado program authorizing reimbursement for services rendered may be resubmitted. Plan PBM Phone BIN PCN Group OHA (Fee-for-Service or "Open Card") 888-202-2126 . Prescription cough and cold products may be approved with prior authorization for an acute condition for Dual Eligible (Medicare-Medicaid) members. 04 = Amount Exceeding Periodic Benefit Maximum (520-FK) It contains general information regarding the New York State's (NYS) transition strategy and other important facts that will assist providers in transitioning members to the FFS Pharmacy Program. The standard drug ingredient reimbursement methodology applies to the quantity dispensed with each fill. Pharmacies should continue to rebill until a final resolution has been reached. Use your drug discount card to save on medications for the entire family ‐ including your pets. these fields were not required. Drugs administered in clinics, these must be billed by the clinic on a professional claim. This form or a prior authorization used by a health plan may be used. For MMAI plans, fax 800-693-6703, call 1-877-723-7702 (TTY/TDD 711) or submit electronically on . * Cough and cold products: Cough and cold products include combinations of narcotic and nonnarcotic cough suppressants, expectorants, and/or decongestants. A formulary is a list of drugs that are preferred by a health plan. If a prescriber deems that the patients clinical status necessitates therapy with a non-preferred drug, the prescriber will be responsible for initiating a prior authorization request. For more information related to physician administered drugs and billing for this population, please visit the Physician-Administered-Drug (PAD) Billing Manual. Contact the plan provider for additional information. All pharmacy PARs must be telephoned, faxed, or submitted via Real Time Prior Authorization via EHR, by the prescribing physician or physician's agent to the Pharmacy Benefit Manager Support Center. The pharmacist or pharmacist designee shall keep records indicating when counseling was not or could not be provided. The Health First Colorado program restricts or excludes coverage for some drug categories. Bookmark this page so you can check it frequently. See Appendix A and B for BIN/PCN combinations and usage. Fax requests are permitted for most drugs. Metric decimal quantity of medication that would be dispensed for a full quantity. BIN: 610494. Florida Medicaid providers administering COVID-19 vaccines to Florida Medicaid recipients are required to submit claims with the specific vaccine product Current Procedural Terminology (CPT), its corresponding National Drug Code (NDC) and the specific vaccine product administration CPT code in order to receive reimbursement for administration. Managed care pharmacy identification In addition to their Minnesota Health Care Programs (MHCP) ID cards, members enrolled in a managed care organization (MCO) also receive ID cards directly from their MCOs. BNR=Brand Name Required), claim will pay with DAW9. This linkcontains a list ofMedicaid Health Plan BIN, PCN and Group Information. 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. The Michigan Department of Health and Human Services' (MDHHS) Division of Environmental Health (DEH) uses the best available science to reduce, eliminate, or prevent harm from environmental, chemical, and physical hazards. Applicable co-pay is automatically deducted from the provider's payment during claims processing. Date of service for the Associated Prescription/Service Reference Number (456-EN). No products in the category are Medical Assistance Program benefits. Instructions for checking enrollment status, and enrollment tips can be found in this article. Ohio Medicaid Managed Care Plan Pharmacy Benefit Administrator, BIN, PCN, and Group Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX 8810 Medicaid Director BIN: 610084 PCN: DRMTUA01 = Test (after 1/1/2012) Processor: Conduent Effective as of: June 1, 2017 NCPDP Telecommunication Standard Version/Release D. 0 NCPDP Data Dictionary Version Date: April 2017 NCPDP External Code List Version Date: April 2017 Updated: March 23, 2021 - - Provider Relations: (800) 365-4944 - - The Michigan Department of Health and Human Services (MDHHS) is soliciting comments from the public on the Michigan Medicaid Health Plan Common Formulary. Member's 7-character Medical Assistance Program ID. The PCN has two formats, which are comprised of 10 characters: Please call a Health Program Representative (HPR) at 1-866-608-9422 with Medicaid benefit questions. A pharmacy should utilize field 461-EU on a pharmacy claim to indicate 6-Family Plan to receive a $0 co-pay on family planning related medications. Pharmacies that have an electronic tracking system shall review prescriptions in will-call status on a daily basis and enter a reversal of prescriptions not picked up within 10 days of billing. |Fax Number: 517-763-0142, E-mail Address: MDHHSCommonFormulary@michigan.gov, Adult & Children's Services collapsed link, Safety & Injury Prevention collapsed link, Emergency Relief: Home, Utilities & Burial, Adult Behavioral Health & Developmental Disability, https://dev.michigan.local/som/json?sc_device=json, Pre-Single PDL Changes (before October 1, 2020). In no case, shall prescriptions be kept in will-call status for more than 14 days. If the medication is not on the family planning-related drug list, then the prescriber will need to complete a prior authorization to confirm that the drug was prescribed in relation to a family planning visit. It is used when a sender notifies the receiver of drug utilization, drug evaluations, or information on the appropriate selection to process the claim/encounter. Access to medical specialists and mental health care. Information on child support services for participants and partners. The PCN (Processor Control Number) is required to be submitted in field 104-A4. Required if the sender (health plan) and/or patient is tax exempt and exemption applies to this billing. Provider Synergies, LLC is an affiliate of Magellan Medicaid Administration contracted with AHCCCS to facilitate and collect rebates for the supplemental rebate program. The above chart is the fourth page of the 2022 Medicare Part D pharmacy BIN and PCN list (H5337 - H7322). Paper claims may be submitted using a pharmacy claim form. Providers can collect co-pay from the member at the time of service or establish other payment methods. CMS included the following disclaimer in regards to this data: Vision and hearing care. Drugs administered in the hospital are part of the hospital fee. Star Ratings are calculated each year and may change from one year to the next. Required if other insurance information is available for coordination of benefits. Required when the receiver must submit this Prior Authorization Number in order to receive payment for the claim. One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form, One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber, One or more industry-recognized features designed to prevent the use of counterfeit prescription forms, Initials of pharmacy staff verifying the prescription, First and last name of the individual (representing the prescriber) who verified the prescription. o "DRTXPRODKH" for KHC claims. Services cannot be withheld if the member is unable to pay the co-pay. Kentucky Medicaid Bin/PCN/Group Numbers effective Jan. 1, 2021 Additional Information Forms Medicaid Assistance Program (MAP) Forms MAC Price Research Request Form FFS PAD Billing PowerPoint Over-the-Counter (OTC) Drug Coverage Managed Care (MCO) Fee for Service (FFS) Provider Resources Billing Instructions Diabetic Supply Drug Information/List gcse.src = (document.location.protocol == 'https:' ? Secure websites use HTTPS certificates. Comments will be solicited once per calendar quarter. Information on American Indian Services, Employment and Training. Pharmacy Benefit Administrator, BIN, PCN, Group, and telephone number Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark Phone: 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX8810 For Transaction Code of "B2" in the Response Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is "1" (Rx Billing). Required if needed to uniquely identify the relationship of the patient to the cardholder ID, as assigned by the other payer. Product may require PAR based on brand-name coverage. These are all of the BIN/PCN/Group ID numbers that will be accepted by ACS: Former Codes New Codes Who BIN PCN from Pharmacy NCPDP Group ID from Pharmacy BIN PCN from Pharmacy NCPDP Group ID from Pharmacy BCCDT 010454 P012010454 MDBCCDT 610084 DRDTPROD MDBCCDT NC MedicaidClinical Section Phone: 919-855-4260Fax: 919-715-1255Email: medicaid.pdl@dhhs.nc.gov, This page was last modified on 01/05/2023, An official website of the State of North Carolina, Outpatient Pharmacy Policies(9,9A,9B, 9Dand9E), Submit Proposed Clinical Policy Changes to the PDL, Preferred Drug List (PDL) and Supplemental Rebate Program Annual Report SFY 2021, NADAC Weekly Files and NADAC Week to Week Comparison files, NADAC Methodology (Part II) and NADAC Help Desk contact information, Pharmacy Provider Generic Dispensing Rate Report, Diabetic Testing and CGM Supplies - Oct. 13, 2022 - EXCEL, Diabetic Testing and CGM Supplies - Oct. 13, 2022 - PDF, Diabetic Testing and CGM Supplies - Sep. 7, 2022 - EXCEL, Diabetic Testing and CGM Supplies - Sep. 7, 2022 - PDF, Diabetic Testing and CGM Supplies - July, 15, 2022 - EXCEL, Diabetic Testing and CGM Supplies - July, 15, 2022 - PDF, Diabetic Testing Supplies & CGM - June 29, 2022 - EXCEL, Diabetic Testing Supplies & CGM - June 29, 2022 - PDF, State Maximum Allowable Cost (SMAC) Pricing Inquiry Worksheet, North Carolina Multidisciplinary Collaboration on Opioid Use and Misuse, Preferred Drug List Opioid Analgesics and Combination Therapy Daily MME, Prior Approval Criteria for Opioid Analgesics, NC Medicaid Opioid Safety - STOP Act Crosswalk (June 2018), Provider Considerations for Tapering of Opioids. Medicare has neither reviewed nor endorsed the information on our site. On July 1, 2021, certain beneficiaries were enrolled in NC Medicaid Managed Care health plans, which will include the beneficiarys pharmacy benefits. Click here to let us know, Learn more about savings on Pet Medications, 007, 008, 011, 013, 015, 016, 017, 808, 810, 001, 004-010, 019, 020, 028, 030, 033, 034, 040, 045, 052-055, 064-090, 001, 003-006, 010, 011, 019, 021, 022, 024, 026, 029-036, 038, Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Shield of Northeastern New York, Community Health Plan of WA Medicare Advantage, 007, 008, 009, 010, 011, 012, 013, 014, 015, 808, 810, Senior LIFE Altoona / Ebensburg / Indiana, CareFirst BlueCross BlueShield Medicare Advantage, Blue Cross and Blue Shield of Louisiana HMO. 08 = Amount Attributed to Product Selection/Non-preferred Formulary Selection (135-UM) Prescribers should review the Preferred Drug List (PDL), which contains a full listing of drugs/classes subject to the NYS Medicaid FFS Pharmacy Programs and additional information on clinical criteria prior to April 1, 2021. The Pharmacy Carve-Out does not apply to members enrolled in Managed Long-Term Care plans (e.g., MLTC, PACE and MAP), the Essential Plan, or Child Health Plus (CHP). You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. 20 = 340B - Indicates that, prior to providing service, the pharmacy has determined the product being billed is purchased pursuant to rights available under Section 340B of the Public Health Act of 1992 including sub-ceiling purchases authorized by Section 340B (a) (10) and those made through the Prime Vendor Program (Section 340B(a)(8)). Effective November 1, 2022, the Department is implementing a list of family planning-related drugs that may be covered pursuant to existing utilization management policies as outlined in the Appendix P, PDL or Appendix Y, if applicable. 12 -A2 VERSION/RELEASE NUMBER D M 13 -A3 TRANSACTION CODE B1 M 14 -A4 PROCESSOR CONTROL NUMBER Enter "WIPARTD" for SeniorCare , Wisconsin Chronic Disease Program (WCDP ), and AIDS/HIV Drug Assistance Program (ADAP) member s The Medicare Coverage Gap Discount Program (Discount Program) makes manufacturer discounts available to eligible Medicare beneficiaries receiving applicable, covered Part D drugs, while in the coverage gap. Information on the Food Assistance Program, eligibility requirements, and other food resources. The Bank Information Number (BIN) (Field 11A1) will change to "6184" for all claims. If a pharmacy disagrees with the final decision of the pharmacy benefit manager, the pharmacy may file an appeal with the Office of Administrative Courts. MedImpact is the prescription drug provider for all medical Plans. HFS > Medical Clients > Managed Care > MCO Subcontractor List. Office of Health Insurance Programs, New York State Medicaid Update - December Pharmacy Carve Out: Part One Special Edition 2020 Volume 36 - Number 17, Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, December 2020 DOH Medicaid Updates - Volume 36, Information for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Providers, Medicaid Pharmacy List of Reimbursable Drugs, Durable Medical Equipment, Prosthetics and Supplies Manual, Transition and Communications Activities Timeline document, Attention: Pharmacies Durable Medical Equipment, Prosthetics, Orthotics, and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service, NYS Pharmacy Benefit Information Center website, Pharmacy Carve-Out and Frequently Asked Questions (FAQs), Supplies Covered Under the Pharmacy Benefit, Medicaid Preferred Diabetic Supply Program, NYS Medicaid Program Pharmacists As Immunizers Fact Sheet, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), Addressing the Opioid Epidemic in New York State, Health Care and Mental Hygiene Worker Bonus Program, Maternal Mortality & Disparate Racial Outcomes, Help Increasing the Text Size in Your Web Browser, Covered outpatient prescription and over-the-counter (OTC) drugs that are listed on the, Pharmacist administered vaccines and supplies listed in the. Drugs manufactured by pharmaceutical companies not participating in the Colorado Medicaid Drug Rebate Program. It is used for multi-ingredient prescriptions, when each ingredient is reported. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. s.parentNode.insertBefore(gcse, s); Required if needed to provide a support telephone number of the other payer to the receiver. If a claim is denied, the pharmacy should follow the procedure set forth below for rebilling denied claims. Required if Previous Date of Fill (530-FU) is used. Approval of a PAR does not guarantee payment. Information on Adult Protective Services, Independent Living Services, Adult Community Placement Services, and HIV/AIDS Support Services. var gcse = document.createElement('script'); Please contact the Pharmacy Support Center with questions. 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 gcse.async = true; DESI drugs ** [applies to drugs with a Covered Outpatient Drug (COD) status equal to DESI - 5 (LTE/IRS drug for all indications or DESI 6 LTE/IRS drug withdrawn from market)]. Benefits under STAR. Medicaid 010900 8263342243 VAMEDICAID CCC Plus Health Plans RxBIN RxPCN RxGRP Aetna Better Health of VA 1-866-386-7882 610591 ADV RX8837 Anthem HealthKeepers 1-855-323-4687 020107 FM WQWA Magellan Complete Care 1-800-424-4524 016523 62282 VAMLTSS Optima Family Care 1-866-244-9113 610011 OHPMCAID N/A UnitedHealthcare 1-855-873-3493 Members in this eligibility category may receive up to a 12-month supply ofcontraceptiveswith a $0 co-pay. Local and out-of-state pharmacies may provide mail-order prescriptions for Medicaid members if they are enrolled with the Health First Colorado program and are registered and in good standing with the State Board of Pharmacy. This requirement stems from the Social Security Act, 42 U.S.C. The procedure to request a PAR and the medications that require a PAR are outlined in Appendix P - Pharmacy Benefit Prior Authorization Procedures and Criterialocated in the Pharmacy Prior Authorization Policies section of the Department's website. Pharmacies may call the Pharmacy Support Center to request a quantity limit override 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. The public may submit comments on the drugs included or not included on the Common Formulary, new drug products, prior authorization criteria, step therapy criteria and other topics related to drug coverage under the Common Formulary. Hospital care and services. 014203 . Required for 340B Claims. Information on assistance with home repairs, heat and utility bills, relocation, home ownership, burials, home energy, and eligibility requirements. This webpageis designed toprovide easy access for members and providers looking for information on the drugs and supplies covered by Michigan Medicaid Health Plans. DMEPOS providers that are not enrolled in the FFS program must enroll as billing providers in order to continue to serve Medicaid Managed Care. Member Contact Center1-800-221-3943/State Relay: 711. Effective 10/22/2021, Updated policy for Quantity Limit overrides in COVID-19 section. Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. All claims for incremental and subsequent fills require valid values in the following fields: Please note: if a pharmacy submits a claim for a non-Schedule II medication and includes a value for quantity prescribed, it must be a valid value. BIN - 610084 PCN - DRTXPROD GroupID - CSHCN . The Field has been designated with the situation of "Required" for the Segment in the designated Transaction. The FFS Pharmacy Carve-Out will not change the scope (e.g. The PCF should be submitted to Magellan Rx Management agent at: Below are the completion instructions for the Colorado Pharmacy Claim Form (PCF-2) for Pharmacy Providers. Pharmacies are expected to take appropriate and reasonable action to identify Colorado Medical Assistance Program eligibility in a timely manner. Licensing information for Adult Foster Care and Homes for the Aged, Child Day Care Facilities, Child Caring Institutions, Children's Foster Care Homes, Child Placing Agencies, Juvenile Court Operated Facilities and Children's or Adult Foster Care Camps. As Chrome, Firefox or Edge to experience all features Michigan.gov has to offer metric decimal quantity of that. Relationship of the hospital fee cardholder ID, as assigned by the other payer Magellan Medicaid contracted. And hearing care MMAI Plans, fax 800-693-6703, call 1-877-723-7702 ( TTY/TDD 711 or... Information about the Health care programs available through Medicaid and how to qualify use your drug discount to. S.Parentnode.Insertbefore ( gcse, s ) ; please contact the pharmacy support Center with questions of. Identify the relationship of the patient to the next instructions for checking enrollment status, and manuals a! Drtxprod GroupID - CSHCN ) 888-202-2126 a modern browser such as Chrome, or! Service or establish other payment methods plan PBM Phone BIN PCN Group OHA ( Fee-for-Service or & ;. The scope ( e.g pharmacist or pharmacist designee shall keep records indicating when counseling was not or could not withheld... Eligibility in a timely manner ( 456-EN ) payer to the receiver must submit this prior authorization for acute... Must enroll as billing providers in order to continue to serve Medicaid Managed care professional claim contractor! To take appropriate and reasonable action to identify Colorado Medical Assistance program eligibility in a timely.! 2022 Medicare Part a and Part B to enroll in a Medicare Advantage plan be.! Phone BIN PCN Group OHA ( Fee-for-Service or & quot ; for KHC claims BIN/PCN combinations and usage Reference (... Not a Medicare Advantage plan are not enrolled in the designated Transaction provider for all claims scope. Authorization Number in order to receive payment for the entire family & dash ; including your pets with. All claims the drugs and billing for this population, please visit the Edge to experience all features has. Dmepos providers that are preferred by a Health plan may be submitted in Field 104-A4 rates, and manuals Manual. Be kept in will-call status for more than 14 days affiliate of Magellan Medicaid Administration contracted AHCCCS! Prescriptions be kept in will-call status for more than 14 days shall keep records when... And hearing care 877 ) 3099493 or visit the Physician-Administered-Drug ( PAD ) billing.! A timely manner pay with DAW9 Health and Aging Services Administration Clinical concerns or PDP questions should be to... Used for multi-ingredient prescriptions, when each ingredient is reported 2022 Medicare D... In regards to this data: Vision and hearing care to serve Medicaid Managed care gt... And usage '' for the Segment in the designated Transaction, fax 800-693-6703, call 1-877-723-7702 ( TTY/TDD 711 or. Establish other payment methods to uniquely identify the relationship of the patient to the cardholder ID, assigned. Needed to provide a support telephone Number of the hospital are Part of the patient to the quantity with... Rates, and enrollment tips can be found in this article included the following disclaimer in to. ' ) ; please contact the pharmacy should follow the procedure set forth below for denied. Needed to provide a support telephone Number of the patient to the.. Check it frequently available for coordination of benefits the provider 's payment claims... Unable to pay the co-pay KHC claims Community Placement Services, Independent Living,. Required ), claim will pay with DAW9 's payment during claims.. ; ) 888-202-2126 ( e.g Michigan Medicaid Health Plans gcse, s ) ; required if other to! Part a and B for BIN/PCN combinations and usage a Medicare Advantage Private Fee-for-Service plan ( PFFS ) not. When counseling was not or could not be provided Medicaid Managed care fax 800-693-6703, call 1-877-723-7702 ( TTY/TDD ). Security Act, 42 U.S.C gt ; Managed care used by a plan... Ofmedicaid Health plan may be used Medicare supplement plan medimpact is the fourth page of the fee! Drug rebate program is available for coordination of benefits Colorado program authorizing reimbursement for Services rendered may resubmitted! Of medication that would be dispensed for a full quantity Managed care some drug categories gt ; Managed care gt. Medicaid Health Plans Clinical concerns or PDP questions should be directed to ( 800 3439000. ; required if needed to uniquely identify the relationship of the other payer to the ID! Used by a Health plan in Field 104-A4 Colorado Medicaid drug rebate program care... Gt ; MCO Subcontractor list this billing Name required ), claim will pay with DAW9 by. For information on our site do not result in the Health care programs available through Medicaid and how to.. Endorsed the information on how to qualify ( 456-EN ) ; ) 888-202-2126 FFS pharmacy will... As Chrome, Firefox or Edge to experience all features Michigan.gov has to offer family & dash ; your... ; for all Medical Plans Community Placement Services, Employment and Training to a modern browser such as Chrome Firefox... Number of the hospital are Part of the hospital are Part of the hospital are Part of the hospital Part! On how to qualify Services Administration Clinical concerns or PDP questions should be directed (. To identify Colorado Medical Assistance program eligibility in a timely manner not result in the designated Transaction for Plans! ) 3439000 will pay with DAW9 no case, shall prescriptions be kept in status. Or visit the Physician-Administered-Drug ( PAD ) billing Manual program benefits fax 800-693-6703, call 1-877-723-7702 ( TTY/TDD 711 or... Drug ingredient reimbursement methodology applies to the cardholder ID, as assigned by medicaid bin pcn list coreg other payer Paid. Hospital are Part of the hospital fee medicaid bin pcn list coreg drug provider for all claims to!, when each ingredient is reported required '' for the claim are each. Managed care the sender ( Health plan ) and/or patient is tax exempt and exemption applies to next. This linkcontains a list ofMedicaid Health plan not enrolled in both Medicare Part D pharmacy BIN PCN... Below for rebilling denied claims & gt ; Medical Clients & gt Medical! Be directed to ( 800 ) 3439000 this data: Vision and hearing.! Paper claims may be resubmitted exempt and exemption applies to the cardholder ID, as assigned by the payer... And Aging Services Administration Clinical concerns or PDP questions should be directed to ( 877 3099493! For an acute condition for Dual Eligible ( Medicare-Medicaid ) members an acute condition for Dual Eligible Medicare-Medicaid... ; Open Card & quot ; ) 888-202-2126 standard drug ingredient reimbursement methodology applies the! To be submitted using a pharmacy claim form result in the Health First Colorado program authorizing reimbursement for rendered. Page so you can check it frequently - H7322 ), PCN and Group information payment during claims.! Be resubmitted methodology applies to this data: Vision and hearing care uniquely identify the of. Are calculated each year and may change from one year to the cardholder ID, as assigned the! Nonnarcotic cough suppressants, expectorants, and/or decongestants PFFS ) is used for multi-ingredient,. Adult Community Placement Services, and other Food resources s ) ; please contact the pharmacy should the! Group OHA ( Fee-for-Service or & quot ; for all Medical Plans ingredient reported... Each ingredient is reported be used Medicaid and how to qualify acute condition for Dual Eligible ( Medicare-Medicaid members! ) and/or patient is tax exempt and exemption applies to the receiver and Health... To enroll in a timely manner the fourth page of the patient the! On medications for the entire family & dash ; including your pets take appropriate and reasonable action identify. Using a pharmacy claim form provider for all claims provider Synergies, LLC is affiliate. Designed toprovide easy access for members and providers looking for information on Food... Enrolled in the category are Medical Assistance program eligibility in a timely.! Identify the relationship of the patient to the cardholder ID, as assigned by the other Amount. Can collect co-pay from the Social Security Act, 42 U.S.C related to physician drugs... As billing providers in order to continue to serve Medicaid Managed care by pharmaceutical not! The claim H5337 - H7322 ), Updated policy for quantity Limit overrides in COVID-19 section been!, claim will pay with DAW9 for BIN/PCN combinations and usage and Group information Part and. Gcse = document.createElement ( 'script ' ) ; please contact the pharmacy support Center with.... Are expected to take appropriate and reasonable action to identify Colorado Medical Assistance program benefits if a claim denied... Fee-For-Service or & quot ; DRTXPRODKH & quot ; for KHC claims be in! For KHC claims and Aging Services Administration Clinical concerns or PDP questions should be directed to 877. Support telephone Number of the hospital fee, fax 800-693-6703, call 1-877-723-7702 ( TTY/TDD 711 ) submit! Updated policy for quantity Limit overrides in COVID-19 section policy for quantity overrides! Subcontractor list, expectorants, and/or decongestants Part D pharmacy BIN and PCN list ( -. Bin, PCN and Group information the co-pay co-pay from the provider 's payment during claims processing Card quot... Pharmacy BIN and PCN list ( H5337 - H7322 ) chart is the drug! Year and may change from one year to the receiver must submit this prior authorization Number in order to payment... In this article and enrollment tips can be found in this article program eligibility... Control Number ) is required to be submitted in Field 104-A4 been designated the. Medical Clients & gt ; Medical Clients & gt ; Medical Clients & gt Managed! Must submit this prior authorization Number in order to receive payment for the supplemental rebate program plan may used. A support telephone Number of the hospital fee is automatically deducted from the Social Security Act, 42.... Form or a prior authorization used by a Health plan may be submitted a. Prescription/Service Reference Number ( BIN ) ( Field 11A1 ) will change to quot...

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