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To: IPA Members From: Heather Rodgers 12/6/06 1.NJ MEDICAID WEBSITE – RESEARCH BENEFICIARY’S ELIGIBILTY AND PDP
Please be aware that the NJ State Medicaid website offers a patient look-up system called eMEVS. This program can provide you with eligibility information and PDP information (excluding PDP ID numbers). If you are experiencing problems with Medicaid/Medicare Dually-Eligibles without information on their PDP or verifying eligibility for members with HBID plastic cards, the eMEVS program will save you time and money.
To access this program please go to www.njmmis.com and click on the eMEVS link located in the first bullet point. If you do not have a Login and Password, you must register for one in the “Provider Registration” link located on the left side of the website. Once you have a login and password you will be able to do member searches for eligibility and patient PDP information without having to make calls or purchase software. Member profiles can be accessed by entering patient Medicaid ID numbers, name, SSN, and DOB.
2. FINAL TRANSITION PHASE FOR MEDICARE PART D PRESCRIPTION DRUG COVERAGE FOR DUALLY-ELIGIBLE BENEFICIARIES Effective for claims with service dates on or after November 21, 2006. Error code 2043 "Recipient Eligible for Medicare Part D" will accompany a denial of payment of pharmacy claims for Medicare Part D covered drugs when a Medicaid beneficiary is determined eligible for Medicare. If you receive an Error Code 2043, the pharmacy should send an E1 Query to determine Part D enrollment. If the E1 Query returns a "no match" response, the pharmacy should submit the claim to Anthem. This will allow the prescription to be filled and will begin the process of enrolling the dually-eligible client in a Part D plan. Pharmacists will have to submit the client's Medicare ID number (known as the HICN), as well as the Medicaid ID number. Both numbers are critical to rapid verification of dual eligibility. The Anthem Prescription Pharmacy Help Desk may be contacted at 800-662-0210 to request further assistance. Also, if you are still getting reject codes 2030 or 2031 (co-pay exceeded $3 or $5), have the patient call their PDP and advise them that they are LIS (Low Income Subsidy) Status 2. Once the PDP corrects this information you should receive a lower co-pay that will process through Medicaid.
3. CONTACT YOUR LEGISLATORS ABOUT MEDICARE PART D PROBLEMS EFFORTLESSLY IPA would like its members to participate in a letter writing campaign to make Legislators aware of the problems pharmacies face regarding Medicare Part D (including AMP, reimbursements, contracts, and improvements). NCPA has some great letters drafted with regard to these issues. These letters can be accessed on IPA’s website (www.ipa-rx.org) or directly at NCPA’s website (www.ncpanet.org) under their Grassroots Network page. The site will write the letter and e-mail it for you! If you have any questions please call Heather Rodgers at 800-575-2667.
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