notice

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March 7, 2012

NOTICE Medicare Part B Process – Reject 70 Employees Retirement System of Texas Effective March 1, 2012 RxBIN: 004336

RxPCN: ADV

RxGRP: RX1292

Effective March 1, 2012, some of the ERS of Texas participants will have coverage through Humana 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 Humana Medicare 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 Humana Medicare Advantage. Please ask the participant to present their Humana ID card and submit the claim to Humana. Logic needed to adjudicate the Humana claims are: RXBIN: 610649 and RXPCN: 03200004. Questions for Humana should be directed to Humana’s pharmacy help desk at 1-800-865-8715.

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 Humana. 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 and click on the Health Professional Services listing. A PDF of the most current payer sheet 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.

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