December 2011 - Prime Therapeutics

Prime Perspective | November 2011Medicare News cont'dDispensing the Accurate Medication is EssentialCMS guidance establishes many requirements with respectto medication errors. The following are common types ofbilling errors:→ → Incorrect drug dispensed→ → Incorrect strength of drug dispensed→ → Drug dispensed to incorrect Covered Persons→ → Incorrect information on the prescription labelBilling errors can result in harm to Covered Persons as well asadditional hardship at the Participating Pharmacy. These errorscan cause confusion for Covered Persons when dispensingprescriptions at Participating Pharmacies.When dispensing prescriptions, Prime requires all ParticipatingPharmacies and staff to double check the Covered Person’sname, ID number, date of birth (DOB), phone number(s),address(es) and medication(s).This will help to improve the accuracy of dispensed prescriptions,reduce medication errors, adverse drug interactions, and helpimprove overall medication use.Uniform Exceptions and AppealsEffective January 1, 2012, CMS requires all Medicare Part Dbenefit sponsors to use a single uniform exceptions and appealsprocess with respect to the determination of prescription drugcoverage for a Covered Person under the plan. Prime will beimplementing the following reject messages to the ParticipatingPharmacy to comply with the final rule:→ → NCPDP Reject Code 569: “Notice of Appeal Rights”→ → Secondary messaging: “Provide Beneficiary withCMS Notice of Appeal Rights”CMS Notice of Appeal Rights will be posted on Prime’s websiteat PrimeTherapeutics.com > Pharmacists > Medicare Part D> Medicare Resources > More > Additional Links > MedicareCoverage & RightsCMS Prescription Drug Event ChangesFor Medicare Part D claims that are processed or reprocessed,a record is sent to CMS. This record is called a Prescription DrugEvent (PDE). CMS will no longer accept PDE records that are sentfor dates of service between 2006 and 2007. Prime will also nolonger reprocess any claims for dates of service between 2006and 2007.CMS has established a 37-month window for submitting PDErecords; the window begins each year on January 31. EffectiveJanuary 31, 2012, CMS will reject PDE records with dates ofservice before 2008. Prime will also no longer reprocess anyclaims for dates of service before 2008 effective January 31, 2012.© Prime Therapeutics LLC5