UnitedHealthcare Community Plan of Nebraska Webinar for Pharmacy Providers
|
|
|
- Amber Walton
- 6 years ago
- Views:
Transcription
1 UnitedHealthcare Community Plan of Nebraska Webinar for Pharmacy Providers Bernadette Ueda, PharmD Pharmacist Account Manager
2 Agenda UnitedHealthcare Community Plan Culture Pharmacy Model Pharmacy Claims Processing Drug Formulary and Prior Authorization Continuity of Care Durable Medical Equipment Immunizations Brand Medically Necessary Drugs Medication Therapy Management Pharmacy Network and Credentialing Specialty Pharmacy Program Pharmacy Resources Contacts 2
3 Our United Culture 3
4 Our Pharmacy Model Member-centric program Clinically appropriate case management drives quality outcomes Focus on cost effective care 4
5 Drug Formulary Nebraska Medicaid, also known as Heritage Health, defines the Preferred Drug List (PDL): The PDL is a subset of all coverable drugs under Medicaid. The Nebraska PDL requires prior authorization on certain medications. The PDL + drugs outside of the PDL = UnitedHealthcare Community Plan Formulary. For more PDL and formulary information, please visit UHCCommunityPlan.com > For Health Care Professionals > Nebraska > Pharmacy Program. 5
6 Prior Authorization Pharmacy point-of-sale messaging notifies pharmacies of prior authorization and edit requirements. Prescribers may submit prior authorizations in three ways: Call Fax Visit UnitedHealthcareOnline.com > Link Sign In > sign in with your Optum ID > Prior Authorization & Notification application Prior authorizations decisions are made in 24 hours. Both the prescriber and member will notified of the decision. 6
7 New Member Continuity of Care Heritage Health will send UnitedHealthcare Community Plan of Nebraska existing prior authorization information for newly enrolled members. Existing prior authorizations will be honored for 90 days or until the end date of the authorization. Continuity of care prescription claims will show a message at point of service: "Transition Benefit, PA req for next fill. 7
8 UnitedHealthcare Community Plan of Nebraska Pharmacy Coverage
9 Durable Medical Equipment (DME) The DME pharmacy benefit covers: Diabetic supplies Meters, strips, lancets, needles, syringes, swabs, testing solution ONE TOUCH brand is preferred Spacers for inhalers Respiratory Saline (0.9%) for use in nebulizers All other DME claims must be submitted through the medical benefit by DME Network Providers. DME contracting is separate from the pharmacy contract. Pharmacies interested in contracting as a DME provider can call or Nebraska_PR_Team@uhc.com. 9
10 Immunizations Vaccines for members 19 and older are processed under the pharmacy benefit. Limited to influenza vaccines, Prevnar and Pneumovax Vaccines for members 18 and younger are available through the Vaccines for Children Program (VFC.) UnitedHealthcare Community Plan will not reimburse for private stock vaccines if they are available through VFC program. To submit immunization claims: Complete claim field 438-E3 (incentive amount submitted) to submit for the $10 administration fee. Populate field 439-E4 (reason for service code) with MA. When the vaccine is provided free by the VFC program, submit an administration fee-only claim with an ingredient cost of $.01 and an admin fee of $10. For more information about the VFC, please call Department of Health and Human Services at or visit DHHS.NE.gov > Public Health > A-Z Topics > Immunizations. 10
11 Brand Medically Necessary Drugs Prior authorizations are required for multi-source branded drug requests if a generic equivalent is available. Multi-source brands will reject with a POS message of Generic Substitution Required unless they re defined as a preferred medication by Nebraska. To process the brand product as a generic, use Dispense as Written (DAW) code 5 at the point of sale. The pharmacy will be reimbursed at the generic rate. DAW Description 0 No DAW Indicated 1 Subst. not allowed by MD 2 Patient Selected Product 3 Pharmacist Selected Prod 4 Product not in Stock 5 Brand Prod Sel. as Gener. 6 Override 7 Prod Mandated by Law 8 Product Not Available 9 Other 11
12 Medication Therapy Management (MTM) UnitedHealthcare s Medication Therapy Management (MTM) helps eligible members better understand their medications and avoid possibly harmful drug combinations. By engaging in MTM services, pharmacies can help promotes PDL and therapy management adherence. Pharmacists are credentialed through vendor/partner and paid based upon services. Qualifying members cases will be routed to their primary pharmacy. First cases will be created in May 2017 approximately. Both telephonic and face to face interventions are allowed. Interventions will consist of Comprehensive Medication Reviews and other targeted activities based on need, such as non-adherence, omissions and specific conditions. Documentation and billing will be captured by MTM partner s web-based platform. Pharmacists are reimbursed for services rendered through the MTM partner. 12
13 UnitedHealthcare Community Plan Network and Credentialing
14 Pharmacy & Provider Network Pharmacy providers must be enrolled with Nebraska Medicaid and contracted with UnitedHealthcare Community Plan of Nebraska for claim reimbursement. Prescriptions must be written by a Nebraska Medicaid participating prescriber. o Any prescriptions written by a non-contracted Nebraska Medicaid physician or other licensed prescriber will be denied at the POS. o Denial reason: "Prescriber Not Covered (NCPDP Reject: 71)." Members will not be reimbursed for cash payments made at an out-of-network, noncontracted pharmacy. o The exception is travel or vacation overrides for non-contracted pharmacies. 14
15 Pharmacy Credentialing To become credentialed, submit an application that includes a complete Disclosure of Ownership and Control Interest Statement Form and applicable information. Credentialing application and contract packet are sent out together with instructions for completion by the pharmacy. Please call to request the application. The standard turn around time for completion is 7 business days or less. The pharmacy contract is finalized after the application review which includes: o Copy of current/valid state licenses (including DEA) with expiration dates o Federal Tax ID permits o Insurance showing adequate coverage o Copy Wholesale Invoice/Drug Purchase Packing Slip o Ownerships and affiliations o Attestations related to disciplinary actions, convictions, restrictions and any other adverse actions o Most recent inspection date by the Board of Pharmacy o Office of Inspector General list of excluded individuals and entities 15
16 Pharmacy Credentialing Standards Pharmacies are credentialed to insure compliance with professional standards such as: o 100 percent point of service capability and ability to use electronic link o Adequate hours of operation o Maintain verifiable record of refill authorizations and signature logs o Allowance of on-site audits o Agree to comply with all Drug Utilization Review (DUR) and plan design parameters All pharmacies are re-credentialed at least every three years. Our contracts with chain pharmacies and Pharmacy Services Administrative Organizations (PSAO) delegate credentialing for all pharmacies within their organization. We contractually require the organization to maintain a credentialing program for itself and member pharmacies. For pharmacy credentialing questions, please call or pharmacycredentialing@optum.com 16
17 Specialty Pharmacy Program This program includes a limited number of pharmacy providers or distribution channels who can handle unique distribution requirements and management needs. Specialty Pharmacy Medications include: Biotechnology products, orphan drug products and high-cost drug products Drug products requiring ongoing, frequent management and patient monitoring by a clinician who specializes in treating the member s condition through: o Focused, in-depth member education o Adherence monitoring o Side effect management o Injection preparation/administration education o REMS programs requiring extensive patient monitoring/management oversight beyond the standard REMS program Drug products with special storage control and/or other specific shipping and handling requirements 17
18 Becoming A Specialty Pharmacy The specialty pharmacy credentialing process ensures only pharmacies that can provide the highest quality services to our members join the network. Applicants who do not meet requirements are given an explanation. Specialty medications are billed through the RxClaims system, like any other pharmacy product To find out more about joining our specialty pharmacy network, please orx_specialty_pharmacy_network_request@optum.com 18
19 Pharmacy Resources
20 Pharmacy Resources Our UnitedHealthcare Community Plan of Nebraska website includes many valuable pharmacy resources, including: The State Preferred Drug List (PDL) Our formulary, including a drug lookup tool Clinical criteria Prior authorization forms Prescriber Reference Guide Maximum Allowable Cost (MAC) program overview and list Directions for submission of pharmacy pricing inquiry Visit UHCCommunityPlan.com > For Health Care Professionals > Nebraska > Pharmacy Program tab 20
21 Pharmacy Credentialing Contacts For assistance with credentialing, please call option 2 or pharmacycredentialing@optum.com. For help with pharmacy contracting, please call , option 2 or provider.relations@optum.com. To find out more about DME contracting, please call or Nebraska_PR_Team@uhc.com. To find out more about specialty pharmacy credentialing, orx_specialty_pharmacy_network_request@optum.com. 21
22 Pharmacy Contacts For assistance with MAC questions, please call , option 7 or rxreimbursement@optum.com. For assistance with pharmacy claims, call To request pharmacy prior authorizations: Call Fax Visit UnitedHealthcareOnline.com > Link Sign In > Prior Authorization & Notification application For any other questions, please contact Bernadette Ueda at or bernadette.ueda@uhc.com. 22
23 Thank You
Pharmaceutical Management Commercial Plans
Pharmaceutical Management Commercial Plans 2015 Toll Free Contact Number: (888) 327-0671 Medical Management: (810) 733-9711 Visit our website at: MclarenHealthPlan.org Introduction Pharmaceutical Management
2018 Medicare Part D Transition Policy
Regulation/ Requirements Purpose Scope Policy 2018 Medicare Part D Transition Policy 42 CFR 423.120(b)(3) 42 CFR 423.154(a)(1)(i) 42 CFR 423.578(b) Medicare Prescription Drug Benefit Manual, Chapter 6,
Pharmaceutical Management Community Plans 2018
Pharmaceutical Management Community Plans 2018 Customer Service: (888) 327-0671 TTY: 711 Pharmacy Administration: (810) 244-1660 Introduction Pharmaceutical management promotes the use of the most clinically
Outpatient Prescription Drug Benefits
Outpatient Prescription Drug Benefits Supplement to Your HMO/POS Evidence of Coverage Summary of Benefits Member Calendar Year Brand Drug Deductible Per Member Applicable to all covered Brand Drugs, including
21 - Pharmacy Services
21 - Pharmacy Services The role of Health Plan of Nevada s (HPN) Pharmacy Services is to evaluate and determine the appropriateness of quality drug therapy while maintaining and improving therapeutic outcomes.
Blue Shield of California Life & Health Insurance Company
Blue Shield of California Life & Health Insurance Company Outpatient Prescription Drug Benefit Rider Insurance Certificate Outpatient Prescription Drug Benefit Summary of Benefits Insured Calendar Year
Pharmaceutical Management Medicaid 2017
Pharmaceutical Management Medicaid 2017 Customer Service: (888) 327-0671 TTY: 711 Pharmacy Administration: (810) 244-1660 Visit our website at: McLarenHealthPlan.org MHP42721056 5/2017 Introduction Pharmaceutical
Martin s Point Generations Advantage Policy and Procedure Form
Martin s Point Generations Advantage Policy and Procedure Form Policy #: PartD.923 Effective Date: 4/16/10 Policy Title: Part D Transition Policy Section of Manual: Medicare Prescription Drug Benefit Manual
2019 Transition Policy
2019 Number: 5.8 Prescription Drug Replaces: 5.8 v.2018 Cross 5.1.2 Transition Fill Monitoring Procedure References: Purpose: To provide guidance on the transition process for new or current Plan members
Prior Authorization All non-emergent services rendered by non-contracted providers require prior authorization, unless specified otherwise.
Prior Authorization All non-emergent services rendered by non-contracted providers require prior authorization, unless specified otherwise. Abortions, Hysterectomies and Sterilizations Ambulance Emergency
TRANSITION POLICY. Members Health Insurance Company
Members Health Insurance Company TRANSITION POLICY POLICY The Company will maintain an appropriate transition process, consistent with 42 CFR 423.120(b)(3), Chapter 6 of the Medicare Prescription Drug
Blue Essentials, Blue Advantage HMO SM and Blue Premier SM Provider Manual - Pharmacy
Blue Essentials, Blue Advantage HMO SM and Blue Premier SM Provider Manual - In this Section there are references unique to Blue Essentials, Blue Advantage HMO and Blue Premier. These network specific
Medicare Advantage Part D Pharmacy Policy
Page 1 of 27 DISCLAIMER NOTICE: The purpose of this policy is to provide guidance for benefit and coverage determinations only. Benefit and coverage determinations are subject to the contractual limitations
Medicare Part D Transition Policy CY 2018 HCSC Medicare Part D
Contract: H0107, H0927, H1666, H3251, H3822, H3979, H8133, H8634, H8554, S5715 Policy Name: Medicare Formulary Transition Purpose: This procedure describes the standard process Health Care Service Corporation
PEP-Portland Clinical Practices Policy Number: CP Policy Owner: Health Plan Operations Manager New Revised Reviewed
Subject: Transition Process for Medicare Part D Approval Group: Pharmacy Management Group Signed By: Ellen Garcia, Executive Director Policy Number: CP5500.120 Policy Owner: Health Plan Operations Manager
All Medicare Advantage Products with Part D Benefits
SUBJECT: TYPE: DEPARTMENT: Transition Process For Medicare Part D Departmental Pharmacy Care Management EFFECTIVE: 1/2017 REVISED: APPLIES TO: All Medicare Advantage Products with Part D Benefits POLICY
Best Practice Recommendation for
Best Practice Recommendation for Exchanging & Processing about Pharmacy Benefit Management Version 020915a Issue Date Version Explanation 10-20-2014 First Release 02-09-15 Clarify language under Health
Prescription Drug Benefits
Stryker s healthcare plan provides benefits for covered prescription drugs, including contraceptives, insulin and diabetic supplies. Benefits are paid for covered drugs that are medically necessary for
Prescription Benefits State of Maryland. CVS Caremark manages your prescription drug benefit under a contract with the State of Maryland.
Prescription Benefits State of Maryland CVS Caremark manages your prescription drug benefit under a contract with the State of Maryland. Introduction This Prescription Benefit document describes how to
Y0076_ALL Trans Pol
Policy Title: Medicare Part D Transition Policy Policy Number: PCM-2018 TB Policy Owner: Antonio Petitta, Vice President Pharmacy Care Management Department(s): Pharmacy Care Management Effective Date:
Indiana Health Coverage Program Seminar Presented by MDwise Pharmacy October 22-24, 2007 P0153 (9/07)
Indiana Health Coverage Program Seminar Presented by MDwise Pharmacy October 22-24, 2007 P0153 (9/07) Overview Pharmacy Benefit Manager Pharmacy Claims Processor Preferred Drug List Pharmacist Override
Life Journey of a Claim
Full Cycle of the Argus System At the Doctor s Office To the Pharmacy At the Pharmacy Entering the Claim The doctor prescribes medication for the patient. Life Journey of a Claim The doctor writes a prescription
SPD Prescription Drugs Plan
Prescription Drugs Plan 08/01/2017 3-1 Your Prescription Drug Benefits The prescription drug benefit available to you is based on the medical plan in which you are enrolled. Regardless of the benefit design
Pharmaceutical Management Medicaid 2018
Pharmaceutical Management Medicaid 2018 Toll-free Contact Number: Pharmacy Administration: (810) 244-1660 MHP42721056 Rev. 2/13/18 Introduction Pharmaceutical Management promotes the use of the most clinically
Texas Vendor Drug Program Pharmacy Provider Procedure Manual
Texas Vendor Drug Program Pharmacy Provider Procedure Manual System Requirements May 2018 The Pharmacy Provider Procedure Manual (PPPM) is available online at txvendordrug.com/about/policy/manual. ` Table
PURPOSE OF THE POLICY STATEMENT OF THE POLICY PROCEDURES
PURPOSE OF THE POLICY The purpose of this policy is to describe Health Alliance s process for transitions and ensure that continued drug coverage is provided to new and current Part D members. The transition
Modernizing Louisiana s Medicaid
Modernizing Louisiana s Medicaid Pharmacy Program Prescription for Reform F i n a l R e f o r m C o n c e p t August 24, 2012 Modernizing Louisiana s Medicaid Pharmacy Program Our Vision: Principles for
SecurityBlue HMO. Link to Specific Guidance Regarding Exceptions and Appeals
SecurityBlue HMO Conditions and Limitations Potential for Contract Termination Disenrollment Rights and Instructions Exceptions, Prior Authorization, Appeals and Grievances Out-of-Network Coverage Quality
2019 Transition Policy and Procedure
2019 Transition Policy and Procedure POLICY Steward Health Choice Generations (SHCG) provides a Part D drug transition process in order to prevent enrollee medication coverage gaps. SHCG s transition process
Prescription Drug Services
Prescription Drug Services Table of Contents Prescription Drug Services... 1 Formulary... 1 Copayments for Drugs... 2 Retail Pharmacy Benefit... 2 Mail Order Pharmacy Benefit... 3 Nonformulary and Prior
BlueRx PDP. Link to Specific Guidance Regarding Exceptions and Appeals
BlueRx PDP Conditions and Limitations Potential for Contract Termination Disenrollment Rights and Instructions Exceptions, Prior Authorization, Appeals and Grievances Out-of-Network Coverage Quality Assurance
FREQUENTLY ASKED QUESTIONS ABOUT THE CVS CAREMARK PRESCRIPTION DRUG PROGRAM
FREQUENTLY ASKED QUESTIONS ABOUT THE CVS CAREMARK PRESCRIPTION DRUG PROGRAM ABBVIE EMPLOYEES WANT TO KNOW 2018 Pharmacy Benefit Changes Q. What is the new prior authorization program? A. Certain brand
Prior Authorization All non-emergent services rendered by non-contracted providers require prior authorization, unless specified otherwise.
Prior Authorization All non-emergent services rendered by non-contracted providers require prior authorization, unless specified otherwise. Abortions, Hysterectomies and Sterilizations Ambulance Emergency
Prescription Drug Benefits
Stryker s healthcare plan provides benefits for covered prescription drugs, including contraceptives, insulin and diabetic supplies. Benefits are paid for covered drugs that are medically necessary for
2015 PacificSource Medicare Part D Transition Process for contracts H3864 & H4754:
2015 PacificSource Medicare Part D Transition Process for contracts H3864 & H4754: Essentials Rx 6 (HMO), Essentials Rx 14 (HMO), Essentials Rx 15 (HMO), Essentials Rx 16 (HMO), Essentials Rx 19 (HMO),
Prescription Drug Coverage
The Company s medical plans automatically include coverage for prescription drugs which is administered by Envision Pharmaceutical Services, Inc. (Envision Rx) for prescriptions filled at retail pharmacies
Sharp Health Plan Outpatient Prescription Drug Benefit
Sharp Health Plan Outpatient Prescription Drug Benefit GENERAL INFORMATION This supplemental Evidence of Coverage and Disclosure Form is provided in addition to your Member Handbook and Health Plan Benefits
Your. Multi-tiered. Prescription Drug Benefit Program. bcnepa.com
Your Multi-tiered Prescription Drug Benefit Program bcnepa.com What you need to know about your multi-tiered prescription drug program A formulary is our list of covered drugs and supplies organized by
Harvard Pilgrim Health Care Pharmacy Services Policy & Criteria. Medicare Advantage Transition of Care
SCOPE: Harvard Pilgrim Health Care Medicare Advantage enrollees, their providers, and all HPHC Pharmacy, Customer Service and Appeals & Grievances Staff. OBJECTIVE: To efficiently provide new enrollees
Subject: Indiana Health Coverage Programs (IHCP) Transition to the National Council for Prescription Drug Programs (NCPDP) Version 5.
P R O V I D E R B U L L E T I N B T 2 0 0 3 6 1 S E P T E M B E R 1 9, 2 0 0 3 To: All Pharmacy Providers Subject: Indiana Health Coverage Programs (IHCP) Transition to the National Council for Prescription
Medicare Transition POLICY AND PROCEDURES
Medicare Transition POLICY AND PROCEDURES POLICY The Plan will maintain an appropriate transition process, consistent with 42 CFR 423.120(b)(3), Chapter 6 of the Medicare Prescription Drug Benefit Manual
Provider Manual Amendments
Amendments L.A. Care Health Plan Revised 11/2015 lacare.org LA1478 11/15 16.0 Pharmacy Overview L.A. Care s prescription drug formulary is designed to support the achievement of positive member health
Your Prescription Drug
Your Prescription Drug BENEFIT PROGRAM This prescription drug benefit program provides pharmacy coverage for you and your family. P r e s c ription Dru g Covered benefits Coverage* includes self-administered
2012 Medicare Part D Transition Process for contracts H3864 & H4754:
2012 Medicare Part D Transition Process for contracts H3864 & H4754: Essentials Rx 6, Essentials Rx 14, Essentials Rx 15, Essentials Rx 16, Premier Rx 7, Explorer Rx 1, Explorer Rx 2, and Explorer Rx 4
MEDICARE PART D POLICY FORMULARY: TRANSITION PROCESS Policy Number: 6-C
MEDICARE PART D POLICY FORMULARY: TRANSITION PROCESS Policy Number: 6-C Coverage Statement This Policy is applicable to: Medco PDP, Beneficiaries, Enhanced PDPs, Client PDPs and Client MA-PDs, to the extent
Consistent with current practice, pharmacies will be paid by a member s plan, subject to its rules, formulary, and rates:
Pharmacy Frequency Asked Questions for ACO launch Claims submission and adjudication 1. How will pharmacy claims be processed starting March 1, 2018? Consistent with current practice, pharmacies will be
Overview of the BCBSRI Prescription Management Program
Overview of the BCBSRI Prescription Management Program A. Prescription Drugs Dispensed at a Pharmacy This plan covers prescription drugs listed on the Blue Cross & Blue Shield RI (BCBSRI) formulary and
APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1
APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 APRIL 2018 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 APRIL 2018 APPENDIX B: VENDOR DRUG PROGRAM Table of Contents
Arkansas State University System Prescription Drug Program
Arkansas State University System Prescription Drug Program The Arkansas State University (ASU) prescription drug program involves a partnership with the University of Arkansas for Medical Sciences (UAMS)
Medicare Part D Transition Policy
Medicare Part D Transition Policy Transition Policy for New and Current Enrollees of our Medicare Part D Prescription Drug Plan PURPOSE: Simply Healthcare Plans, Inc. must maintain an appropriate transition
2018 Transition Fill Policy & Procedure. Policy Title: Issue Day: Effective Dates: 01/01/2018
Policy Title: Department: Policy Number: 2018 Transition Fill Policy & Procedure Pharmacy CH-MCR-PH-01 Issue Day: Effective Dates: 01/01/2018 Next Review Date: 04/01/2018 Revision Dates: 05/19/2016 11/14/2016
Re: Medicare Prescription Drug Benefit Manual Draft Chapter 5
September 18, 2006 BY ELECTRONIC DELIVERY Cynthia Tudor, Ph.D. Director, Medicare Drug Benefit Group Centers for Medicare and Medicaid Services Department of Health and Human Services Mail Stop C4-13-01
PRESCRIPTION DRUG EXPENSE BENEFIT 2019
PRESCRIPTION DRUG EXPENSE BENEFIT 2019 Welcome to the Prescription Drug benefit, administered by Express Scripts, Inc. (ESI). To receive the highest level of benefits, prescription drugs must be obtained
Harvard Pilgrim Health Care Pharmacy Services Policy & Criteria. Medicare Advantage Transition of Care
SCOPE: Medicare Advantage enrollees, their providers, and all HPHC Pharmacy, Customer Service and Appeals & Grievances Staff. OBJECTIVE: To avoid interruption in therapy, timely access to a temporary supply
Values Accountability Integrity Service Excellence Innovation Collaboration
n04231 Medicare Part D Transition and Emergency Fill Policy Values Accountability Integrity Service Excellence Innovation Collaboration Abstract Purpose: The Medicare Part D Transition and Emergency Fill
Pharmacy Billing and Reimbursement
FSHP Disclosure Pharmacy Billing and Tara L McNulty RPhT, CPhT I, Tara McNulty, do not have a vested interest in or affiliation with any corporate organization offering financial support or grant monies
POLICY / PROCEDURE No. PH-917 MMM-PHA-POL E. Transition Process
POLICY / PROCEDURE No. PH-917 MMM-PHA-POL-380-06-06012016-E Revision Letter 10/3/2016 1.0 Purpose This policy and procedure outlines the MMM Healthcare process for complying with Medicare Part D transition
Table of Contents. Texas Vendor Drug Program Overview Requirements Envolve Communication Notices...
Superior HealthPlan Table of Contents Texas Vendor Drug Program Overview 5 Requirements 6 Envolve Communication Notices.... 7-11 Superior HealthPlan Overview..14-23 Benefit Design.. 24 Envolve Pharmacy
APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1
APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2015 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2015 APPENDIX B: VENDOR DRUG PROGRAM Table of
Health PAS-Rx Help Desk Hints Version 1.58 West Virginia Medicaid Health PAS-Rx Help Desk Hints
West Virginia Medicaid Health PAS-Rx Help Desk Hints Date of Publication: 12/15/2017 Document Version: 1.58 Privacy and Security Rules The Health Insurance Portability and Accountability Act of 1996 (HIPAA
Farm Bureau Select Rx 2017 Summary of Benefits January 1, December 31, 2017
P.O. Box 266380 Weston, FL 33326 Farm Bureau Select Rx 2017 Summary of Benefits January 1, 2017 - December 31, 2017 Thank you for your interest in Farm Bureau Select Rx, Our plan is offered by Members
Excellus BlueCross BlueShield Participating Provider Manual. 5.0 Pharmacy Management
Excellus BlueCross BlueShield Participating Provider Manual 5.0 Pharmacy Management 5.1 Pharmacy Benefits The Health Plan is committed to effectively managing prescription drug benefit costs and providing
Summary Plan Description Accenture Prescription Drug Plan
Summary Plan Description Accenture Prescription Drug Plan Effective January 1, 2018 Group Number: ACCRXS1 TABLE OF CONTENTS SECTION 1 - WELCOME... 1 SECTION 2 PLAN HIGHLIGHTS... 3 SECTION 3 - ADDITIONAL
Share a Clear View PHARMACY BENEFIT
Share a Clear View PHARMACY BENEFIT Share a Clear View NAVITUS CUSTOMER CARE HOURS: 24 Hours a Day 7 Days a Week 866-333-2757 (toll-free) TTY (toll-free) 711 MAILING ADDRESS: Navitus Health Solutions P.O.
Chapter 17: Pharmacy and Drug Formulary
Chapter 17: Pharmacy and Drug Formulary Introduction Health Choice Insurance Co. (Health Choice) is pleased to provide the Health Choice Formulary, which is available on line at www.healthchoiceessential.com/members/rxdrugs.
Community Care, Inc. Medicare Part-D Enrollee Transition Plans H5212 PACE and H2034 HMO-SNP 2018
Title: and H2034 HMO-SNP 2018 Policy Identifier: PA - Pharmacy Effective Date: 20180101 Scope: Organization Wide Family Care PACE Partnership Waukesha Day Center HUD (Housing and Urban Development) Department:
UNDERSTANDING & MAKING THE MOST OF YOUR PHARMACY BENEFITS
UNDERSTANDING & MAKING THE MOST OF YOUR PHARMACY BENEFITS Prescription drug benefits are an important part of your medical plan benefit. Here s how you can find important information to help you understand,
Prescription Medication Schedule of Benefits
Prescription Medication Schedule of Benefits Rx Member Cost-Sharing: $15/$35/$70/$70 When you go to a pharmacy that participates in the UPMC Health Plan pharmacy network, you will be able to receive coverage
I. PURPOSE. A. The primary objectives of Molina Healthcare s Transition Policy and Procedure are:
I. PURPOSE The purpose of the Policy and Procedure is to ensure necessary continuity of treatment and to provide adequate time and transition process to introduce the enrollee and their prescribing physician
Prescription Drug Rider
Prescription Drug Rider Rx Member Cost-Sharing: $10/$25/$40/$40 According to this prescription drug program, you may receive coverage for prescription drugs in the amounts specified in your rider when
Prescription Drug Schedule of Benefits
Prescription Drug Schedule of Benefits Rx Member Cost-Sharing: $5/$15/$35/$35 When you go to a pharmacy that participates in the UPMC Health Plan pharmacy network, you will be able to receive coverage
Medicare Part D Transition IHM Departmental Policy
Medicare Part D Transition IHM Departmental Policy Document Number: DP.063 Version #: 1.0 Document Owner: Chad Murphy, Vice President, Pharmacy and Date of Last Update: Contracting 07/25/2017 Business
Contents General Information General Information
Contents General Information... 1 Preferred Drug List... 2 Pharmacies... 3 Prescriptions... 4 Generic and Preferred Drugs... 5 Express Scripts Website and Mobile App... 5 Specialty Medicines... 5 Prior
Prescription Medication Rider
Prescription Medication Rider Rx Member Cost-Sharing: $16/$40/$80/$90 According to this prescription medication program, you may receive coverage for prescription medications in the amounts specified in
The following questions were received in response to our provider webinars presented by Blue Shield of California s network management teams.
Ancillary Claims Filing Requirements Frequently Asked Questions The following questions were received in response to our provider webinars presented by Blue Shield of California s network management teams.
Contract Summary. OptumRx Administrative Services, LLC
Attachment C Contract Summary OptumRx Administrative Services, LLC Subcontractors This contract includes the following subcontractors or pass through to other providers. Name Service(s) Amount Interpreting
Magellan Complete Care of Virginia (MCC of VA) Provider Training. July 2017
Magellan Complete Care of Virginia (MCC of VA) Provider Training July 2017 A Managed Long Term Services and Supports Program On August 1, 2017, Magellan Complete Care of Virginia (MCC of VA) part of the
Classification: Clinical Department Policy Number: Subject: Medicare Part D General Transition
Classification: Clinical Department Policy Number: 3404.00 Subject: Medicare Part D General Transition Effective Date: 01/01/2019 Process Date Revised: 07/20/2018 Date Reviewed: 05/29/2018 POLICY STATEMENT:
Rx Benefits. Generic $10.00 Brand name formulary drug $30.00
Rx Benefits VCCCD - Faculty Custom Prescription Drug Benefits Mandatory Generic Substitution This summary of benefits has been updated to comply with federal and state requirements, including applicable
POLICY STATEMENT: PROCEDURE:
PAGE 1 OF 12 POLICY STATEMENT: NPS shall provide an automated process to assist beneficiaries who are transitioning from drug regimens or therapies that are not covered on the Part D Plan S are on the
Your Pharmacy Benefits Handbook
Your Pharmacy Benefits Handbook Summary of FCPS Prescription Benefits Available Through CVS Caremark Pharmacy Benefit Manager for Aetna/Innovation Health and CareFirst BlueChoice Advantage Plans Plan Year
Contract Summary. OptumRx Administrative Services, LLC
Contract Summary OptumRx Administrative Services, LLC Subcontractors This contract includes the following subcontractors or pass through to other providers. Name Service(s) Amount Interpreting Services
Farm Bureau Essential Rx 2018 Summary of Benefits January 1, December 31, 2018
Farm Bureau Health Plans P.O. Box 266380 Weston, FL 33326 Farm Bureau Essential Rx 2018 Summary of Benefits January 1, 2018 - December 31, 2018 Thank you for your interest in Farm Bureau Essential Rx.
Kroll Ontrack, LLC Prescription Drug Plan. Plan Document and Summary Plan Description
Kroll Ontrack, LLC Prescription Drug Plan Plan Document and Summary Plan Description Effective December 9, 2016 Kroll Ontrack, LLC reserves the right to amend the Kroll Ontrack, LLC Health & Welfare Plan
Chapter 10 Prescriptions Benefits and Drug Formulary
10 Prescription Benefits and Drug Formulary Health Choice Generations is a Medicare Advantage Special Needs Plan (SNP) with Medicare Part D Prescription Drug Coverage. Medicare Part D drugs covered by
1 INSURANCE SECTION Instructions: This section contains information about the cardholder and their plan identification.
1 INSURANCE SECTION : This section contains information about the cardholder and their plan identification. 1 ID of Cardholder Required. Enter the recipient s 13 digit Medicaid ID. 2 Group ID Not Required.
Patient Enrollment Guide
Patient Enrollment Guide Completing the Patient Enrollment Form Prescribing Healthcare Professional (HCP) Contact Information HCP Fax Number Please list accurate fax number where patient Summary of Benefits
SBCFF Modified Rx 10/30/45 Prescription Drug Benefits
Rx Benefits SBCFF Modified Rx 10/30/45 Prescription Drug Benefits This summary of benefits has been updated to comply with federal and state requirements, including applicable provisions of the recently
Medicaid Modernization: How to Build a Relationship with an MCO
Medicaid Modernization: How to Build a Relationship with an MCO 2015/2016 Agenda Building a positive relationship with providers is critical to a smooth transition to managed care. We are here to help
summary of benefits Blue Shield of California Medicare Rx Plan (PDP)
summary of benefits Blue Shield of California Medicare Rx Plan (PDP) An employer-sponsored Medicare Prescription Drug Plan for City and County of San Francisco retirees, spouses and eligible dependents
PROVIDER CREDENTIALING AND VERIFICATION TO THE PARTICIPATING PHARMACYAGREEMENT
PROVIDER CREDENTIALING AND VERIFICATION TO THE PARTICIPATING PHARMACYAGREEMENT Please take the following steps to apply for access to the EnvisionRx Pharmacy Network Step One: Step Two: Complete the application
Prescription Medication Rider
Prescription Medication Rider Rx Member Cost-Sharing: $16/$40/$80/$90 HealthyU HIA/HRA According to this prescription medication program, you may receive coverage for prescription medications in the amounts
Chapter 21. Pharmacy Services
Last Updated: 11/14/2018 1:52:00 PM Chapter 21 Pharmacy Services Definitions Compounded Prescription: A prescription prepared in accordance with Minnesota Rules 6800.3100. Dispensing Date: The actual date
Your Prescription Drug Plan. Prescription Drug Plan CONTENTS PRESCRIPTION DRUG PLAN. (Performance Pipe Hourly Employees)
(Performance Pipe Hourly Employees) Prescription Drug Plan CONTENTS Your Prescription Drug Plan...C-1 How the Plan Works...C-2 What s Covered...C-7 Precertification...C-7 Prescription Drug Management Programs...
The State of New Mexico Group Benefits Plan Plan Year: January December 2018 Prescription Drug Program
The State of New Mexico Group Benefits Plan Plan Year: January December 2018 Prescription Drug Program 1 Who Is Express Scripts? Express Scripts administers your prescription drug benefit and you automatically
PHARMACY BENEFIT MEMBER BOOKLET
PHARMACY BENEFIT MEMBER BOOKLET Printed on: VALUE, QUALITY AND CONFIDENCE Costco Health Solutions Customer Care HOURS: 24 Hours a Day 7 Days a Week (877) 908-6024 (toll-free) TTY 711 MAILING ADDRESS: Costco
Glossary of Terms (Terms are listed in Alphabetical Order)
Glossary of Terms (Terms are listed in Alphabetical Order) Access Access refers to the availability and location of pharmacies that participate in the network that serves your pharmacy benefit plan. Acute
Texas Vendor Drug Program. Pharmacy Provider Procedure Manual Coordination of Benefits. Effective Date. February 2018
Texas Vendor Drug Program Pharmacy Provider Procedure Manual Coordination of Benefits Effective Date February 2018 The Pharmacy Provider Procedure Manual (PPPM) is available online at txvendordrug.com/about/policy/manual.
POLICY AND PROCEDURE DEPARTMENT: Pharmacy Operations
PAGE: 1 of 6 SCOPE: Centene Corporate Pharmacy Solutions, Health Plan Pharmacy Departments, Centene Pharmacy and Therapeutics Committee, Health Plan Pharmacy and Therapeutics Committees, Envolve Pharmacy
State Health Plan 101
State Health Plan 101 2017 Pharmacy Benefit Changes November 2016 Agenda New Pharmacy Benefit Manager Pharmacy Benefits Overview and Changes Q&A session 2 New Pharmacy Benefit Manager As of Jan. 1, 2017,