notice

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August 20, 2012

NOTICE Medicare Part B Process – Reject 70 Employees Retirement System of Texas Effective September 01, 2012 RxBIN: 004336

RxPCN: ADV

RxGRP: RX1292

Effective September 01, 2012, some of the ERS of Texas participants will have coverage through Kelsey Medicare Advantage for Medicare Part B drugs and some participants will continue to have coverage through Medicare for Part B drugs.

How the Med B Initiative at the Point of Service works: •

Members with coverage through Medicare for Part B: The claim may adjudicate as “REJECTED” with a reject 70 <> with supplemental messaging <>. If your pharmacy accepts assignment of benefits for Medicare Part B, you would follow your normal process for submitting these claims to Medicare Part B.

•

Members with coverage through Kelsey Care Advantage for Part B: The claim may adjudicate as “REJECTED” with a reject 70 <> with supplemental messaging <>. If you submit to Medicare – you may get a rejection from Medicare since the participant has coverage through KelseyCare Advantage. Please ask the participant to present their KelseyCare Advantage card and submit the claim to KelseyCare Advantage. Logic needed to adjudicate the KelseyCare Advantage claims are: KCA ID: KCAXXXXXXXX RXBIN: 015764 and RXPCN: 05900001. Questions regarding Part B drugs should be directed to KelseyCare Advantage Member Services at 713-442-2ERS (2377).

If your pharmacy DOES NOT accept Assignment of Benefits for Medicare Part B If your pharmacy currently DOES NOT accept assignment of benefits for Medicare Part B, please let the participant know that your pharmacy does not accept assignment for Medicare Part B claims, and you can have the plan participant pay cash at the point of service and submit the claim to Medicare Part B as required by Medicare or to Kelsey. If the participant is unsure of whom to submit the claim to, ask them to call Caremark at 1-888-886-8490.

If the plan participant informs you they are not in Medicare Part B, please call the Caremark Pharmacy Help Desk at 1-800-364-6331 to request an override for the plan participant. If you need a payer sheet for more information on diagnosis codes required by Caremark, please visit the Caremark web-site at www.caremark.com/pharminfo or www.caremark.com > For Pharmacists and Medical Professionals > Downloadable Forms and Guides. PDFs of the most current payer sheets can be printed or downloaded. If you have questions, please call the Pharmacy Help Desk at 1-800-364-6331. Thank you for delivering high-quality, cost-effective pharmacy services to ERS of Texas plan participants. This communication and any attachments may contain confidential information. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution, or copying of it or its contents, is prohibited. If you have received this communication in error, please notify the sender immediately by telephone and destroy all copies of this communication and any attachments. This communication is a Caremark Document within the meaning of the Provider Manual.

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