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To: IPA Members From: Heather Rodgers 4/6/06
1. MEDICARE PART D / PAAD: To save time and frustration, please make sure you get your Medicare D / PAAD patients’ Social Security Number (SSN) before they leave the counter. If there is a problem with the claim, you will most likely need the patient’s SSN to get the appropriate / correct card information. Also, to avoid unnecessary audits and chargebacks, please be sure you make every attempt to get a prior authorization. When you bill a Medicare Part D plan, you may get a “NDC not covered” or “plan limits exceeded” rejection message. All attempts must be made to either get a prior authorization or have the MD change the Rx to a formulary medication. While you are waiting for the PDP response, you can bill a 6 day emergency supply through Medicaid/PAAD. The PDP’s have 6 days to either approve / deny the medication. The medication should only be billed though Medicaid / PAAD after the PDP has denied it. The State Should Only Be Billed as a Last Resort.
2. NJ LAW CE REQUIREMENTS: For the NJ registration period beginning May 2005, pharmacists must obtain 3 CE credits in pharmacy law. Clarification from the Board of Pharmacy states that any ACPE accredited program that ends in “03” is considered a law topic. It can be either live or home study and cover either federal law or NJ state law. 3. AARP / UNITED HEALTHCARE MISSING CHECKS AND CLAIMS: Please make sure that you received your first check from WHI (Walgreens). Be advised, WHI is sending the remittance statement and the check separately. The remittances for the first check were received, but some the checks never followed. Please make sure you got this check. It has also been brought to our attention there have been some unpaid claims that adjudicated at the time of service. On February 8th & 9th, there are several claims missing from the remittance statement / check for that cycle. Please make sure you were paid for all claims filled during this period. If you did not receive your check or are missing claims, please contact Heather Rodgers of IPA @ 800-575-2667 or Julie DeVita of Walgreen’s @ 847-940-2201. Thank you to the IPA Board for helping with this information. If you have any questions or third party issues, please contact Heather Rodgers at 800-575-2667. |