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To: IPA Members From: Heather Rodgers/John Covello 4/22/08
GOOD NEWS ON AETNA COB RECOVERY. By now you have received the letter from Aetna explaining a COB Recovery Program for your Part D dual eligible Aetna/PAAD claims processed from 1/1/08 - 2/22/08. These claims were COB overpayments by Aetna and should have been coordinated with PAAD. The letter requests the pharmacy reverse and resubmit all claims to Aetna and PAAD to correct this problem (even ones with an estimated $0 recovery). The recovery figure is only estimated and an accurate claim is needed so patients’ Medicare Accumulators (ex. LICS balances) are adjusted. Then submit the remaining balance to PAAD to collect the wrap-around.
If you choose not to reverse and resubmit these claims in the 45 days allowed by Aetna, they will recapture the money from future payments and the pharmacy will not be eligible for the PAAD wrap-around.
Because this problem is fully Aetna’s responsibility, Aetna indicated they would be providing pharmacies with compensation for pharmacists who have reversed and resubmitted claims, including zero balances. The details of this compensation program will be finalized over the next two weeks. We will keep you informed as more details become available.
If you have any problems with reversals or rejections, call the Aetna help desk (800‑AETNA‑RX) or the PAAD help line (866-854-1596).
If you have any other questions regarding this matter please contact Heather Rodgers, Senior Member Services Administrator or John Covello, Executive Director of Government and Public Affairs at IPA at 800-575-2667 or info@ipagroup.org.
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