December 2011 - Prime Therapeutics

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New Plan AnnouncementBlue Cross Blue Shield of Arizona Medicare Part DEffective January 1, 2012Effective January 1, 2012, Prime Therapeutics will begin processingMedicare Part D claims for Covered Persons of Blue CrossBlue Shield of Arizona (BCBSAZ) Blue MedicareRx (PDP).Processing RequirementsTo ensure uninterrupted service to Participating Pharmacies andCovered Persons, please use the following information to set upsystems prior to January 1, 2012.BCBSAZ PDP IndividualBIN:........................................610455PCN:.......................................PDPAZBCBSAZ PDP Employer GroupBIN:........................................610455PCN:.......................................PDGAZCovered Person ID Number2011 Outstanding Claims Reversals and Processing→→Participating Pharmacies should complete all claims processingand reversals by close of business December 31, 2011→→Medicare Part D claims with a fill date after January 1, 2012must be submitted with the BIN/PCN outlined aboveFor More Information→→For Prime’s helpful resources for Medicare Part D coverageand issues, please visit: PrimeTherapeutics.com > Pharmacists> Medicare Part D > Medicare Resources > Helpful Resources→→Prime’s Medicare Part D PDP and MA-PD payer specificationsheet is available at: PrimeTherapeutics.com > Pharmacists >D.0/Version 5010 Pharmacy Information > D.0 Payer Sheets→→If you have questions regarding claims processing,please contact Prime’s Contact Center at 877.878.8668Date of BirthGenderGroup NumberPerson CodeU&CDays SupplyPharmacy NPIPrescriber ID (NPI or DEA only; UPIN when allowed)Date Rx WrittenPrescription Origin CodeFeatured below are examples of the most common ID cardsused for BCBSAZ Individual Blue MedicareRx:10 © Prime Therapeutics LLC
Prime Perspective | November 2011Prime NewsNCPDP Version D.0 Claim Submission RequirementsEffective January 1, 2012 pharmacies are required to submit claimsto Prime in the D.0 format. Prime recommends ParticipatingPharmacies convert to the D.0 format before January 1, 2012.In order for Prime to assess the networks’ readiness, Pharmaciesmust attest to their ability to submit D.0 claims beginningJanuary 1, 2012. Effective March 31, 2012 Prime will only acceptclaims submitted in the D.0 format.For more information regarding the CMS statement released onNovember 17, 2011 go to the following link: https://www.cms.gov/ICD10/Downloads/CMSStatement5010EnforcementDiscretion111711.pdfConvert to the D.0 Format to Prevent Covered Person DisruptionTo prevent disruption for the Covered Person, if a ParticipatingPharmacy is not compliant with the D.0 format by March 31, 2012,Prime will send a communication to Covered Persons advising theutilization of alternate Participating Pharmacies.→→Payer Sheet Information Prime’s D.0 payer specificationsheets may be found at PrimeTherapeutics.com >Pharmacists > D.0/Version 5010 Pharmacy Information> D.0 Payer Sheet ASC X12/005010X221A1→→Prime is ready to convert 835 ERA files from the 4010 to5010 version. To request to be converted from the 4010to 5010 version or to request a test 5010 ERA file, pleasecontact pharmacyops@primetherapeutics.com.→→For D.0 or version 5010 related questions, please contactpharmacyops@primetherapeutics.comD.0 Changes Impacting Multiple Ingredient CompoundsIn September 2011, Prime began accepting claims in both theNCPDP 5.1 and D.0 formats. In conjunction with accepting dualstandard claims, Prime started accepting multiple ingredientcompound submissions.See guidelines below to assist in submitting a multiple ingredientcompound claim to Prime:→ → Prime will accept a multiple ingredient compound submissionutilizing NCPDP’s Compound Segment for up to 25 ingredients.→ → Prior authorizations previously issued for processing acompound may no longer apply.→ → Dynamic prior authorizations for processing compounds whichcontain situational Medicare Part B versus Medicare Part Ddrugs will no longer apply, even if the compound meets thecriteria for inclusion as a Medicare Part D covered drug.A one-time prior authorization will be issued if the claimmeets the criteria for coverage under Medicare Part D.→ → Submission clarification codes will be supported for bothPrime’s Commercial and Medicare Programs business.In the situation where an ingredient within the compoundis not covered, the Participating Pharmacy can submit thesubmission clarification code of “08” and the previouslyrejected claim will process to allow payment of all coveredingredients.→→Compounds containing a Medicare Part B ingredient must beprocessed under Medicare Part B.If you have questions regarding claims processing, please contactPrime’s Contact Center at 800.821.4795© Prime Therapeutics LLC11
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December 2011 - Prime Therapeutics

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