Coventry Health Care 2009 Medicare Part D New Plan Sponsor

Medco Health Solutions, Inc.
100 Parsons Pond Drive
Franklin Lakes, NJ 07417
Fax: 1 201 269-5262
www.medco.com/rph
Coventry Health Care
2009 Medicare Part D New Plan Sponsor
Announcement:
Beginning January 1, 2009 Medco will be administering the Medicare Part D prescription drug benefit
on behalf of Coventry Health Care for 1.2 million Medicare beneficiaries.
Coventry Health Care offers Medicare Part D prescription drug programs to Medicare-eligible beneficiaries as
both a stand-alone Prescription Drug Plan (PDP) and a Medicare Advantage plan with integrated Part D drug
coverage (MA-PD). Some examples of Coventry Health Care’s Plans are listed below, and attached are
sample prescription ID cards.
Action requested:
Temporary
Coverage
Override Process
(TCO):
Members may receive their new ID cards prior to January 1, 2009. Please continue to process their
claims to the current PBM until January 1, 2009.
Effective January 1, 2009, pharmacies should process claims for Coventry Health Care beneficiaries using the
TelePAID ® System with the following mandatory fields needed for successful claims processing:
The new RxBIN: 610014
The new RxPCN: MEDDPRIME
The new RxGroup #: As listed on the member ID card. See Rx Group numbers listed below.
The member’s 11-digit ID number
Note: For members with integrated medical and pharmacy benefits with Coventry Health Care, claims for
both Medicare Part D and Part B prescriptions should be submitted to the same Rx Group # listed under the
RxPCN on the ID card. For claims rejecting for eligibility, please re-confirm the member’s new ID #, RxBIN,
RxPCN, RxGroup #, and resubmit the claim.
A Temporary Coverage Override (TCO) may be available during the first 90 days of eligibility for new
members enrolled in a Coventry Health Care plan. During the first 90 days of eligibility, ambulatory patients
may receive up to a one-time 30-day supply, and LTC beneficiaries may receive multiple fills during this time
period, as appropriate.
When a claim rejection for nonpreferred drug, step therapy, or prior authorization is returned and you are
unable to contact the physician, a TCO may be used as an exception when displayed in the POS message.
The rejection may be NCPDP reject 70 or 75.
When TCO is displayed, please follow these steps to process a claim:
• Enter “01= Prior Authorization” in the Prior Authorization Type field
• Enter the code (normally 11111) in the Prior Authorization Number field
Formulary:
Sample ID Cards:
In addition to the TCO, ambulatory patients are eligible for a subsequent 3-day emergency supply, and LTC
beneficiaries are eligible for a subsequent 31-day emergency supply. Emergency supplies are applicable
during and after the first 90 days of eligibility. Call the Pharmacy Services Help Desk at
1 800 922-1557 for appropriate override code.
Formulary updates can be viewed by visiting the following websites:
www.advantrarx.com, www.firsthealthpartd.com, www.chcadvantra.com, and
www.advantrafreedom.com
For general
questions:
Contact the Medco Pharmacy Services Help Desk at 1 800 922-1557, or visit the Pharmacist Resource
Center at www.medco.com/rph.

Coventry Health Care Medicare Part D Plan Names
Plan Name Type RxPCN RxGroup # ID# format
Advantra MAPD MEDDPRIME CVTYMED 11-digits
Advantra MA CVTYMEB 11-digits
Advantra Advantage MAPD-CCP MEDDPRIME CVTYMED 11-digits
Advantra Extra MAPD-CCP MEDDPRIME CVTYMED 11-digits
Advantra Freedom MAPD-PFFS MEDDPRIME CVTYMED 11-digits
Advantra Freedom MA-PFFS CVTYMEB 11-digits
Advantra Freedom Freedom 5 Plus MAPD-PFFS MEDDPRIME CVTYMED 11-digits
Advantra Gold MAPD-CCP MEDDPRIME CVTYMED 11-digits
Advantra Option 3 MAPD-CCP MEDDPRIME CVTYRTL 11-digits
Advantra Option 3 SPAP Rx Basic MAPD-CCP MEDDPRIME CVTYRTL 11-digits
Advantra Option 3 SPAP Rx Plus MAPD-CCP MEDDPRIME CVTYRTL 11-digits
Advantra Platinum MAPD-CCP MEDDPRIME CVTYMED 11-digits
Advantra PPO Diamond MAPD-CCP MEDDPRIME CVTYMED 11-digits
Advantra PPO Gold MAPD-CCP MEDDPRIME CVTYMED 11-digits
Advantra PPO Silver MAPD-CCP MEDDPRIME CVTYMED 11-digits
Advantra Premium MAPD-CCP MEDDPRIME CVTYMED 11-digits
Advantra Silver MAPD-CCP MEDDPRIME CVTYMED 11-digits
AdvantraOne MAPD-CCP MEDDPRIME CVTYMED 11-digits
AdvantraOne MAPD-CCP MEDDPRIME CVTYRTL 11-digits
AdvantraRx PDP MEDDPRIME CVTYMED 11-digits
AdvantraRx Premier PDP MEDDPRIME CVTYMED 11-digits
Altius Advantra Bronze MAPD-CCP MEDDPRIME CVTYMED 11-digits
Altius Advantra Gold MAPD-CCP MEDDPRIME CVTYMED 11-digits
Altius Advantra Silver MAPD-CCP MEDDPRIME CVTYMED 11-digits
Carelink MAPD MEDDPRIME CVTYMED 11-digits
Coventry Advantra Platinum Plus PPO MAPD-CCP MEDDPRIME CVTYMED 11-digits
Coventry Advantra Silver MAPD-CCP MEDDPRIME CVTYMED 11-digits
Coventry Advantra Silver MAPD-CCP MEDDPRIME CVTYMED 11-digits
Coventry AdvantraExtra MAPD-CCP MEDDPRIME CVTYMED 11-digits
Coventry AdvantraOne MAPD-CCP MEDDPRIME CVTYMED 11-digits
Coventry AdvantraOne MAPD-CCP MEDDPRIME CVTYRTL 11-digits
Coventry Atlanta Gold MAPD-CCP MEDDPRIME CVTYMED 11-digits
First Health Part D Premier PDP MEDDPRIME CVTYRTL 11-digits
First Health Part D Secure PDP MEDDPRIME CVTYRTL 11-digits
GoldAdvantage MAPD-CCP MEDDPRIME CVTYMED 11-digits
Premium MAPD-PFFS MEDDPRIME CVTYMED 11-digits
Premium Rx MAPD-PFFS MEDDPRIME CVTYMED 11-digits
Medco is the company many of your customers' employers or health plans have chosen to manage
their prescription drug benefits.
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