Pharmacy FROM


[PDF]DATE: July 31, 2012 TO: Third Party/Pharmacy FROM - Rackcdn.comec136126026ae0ee21c6-6b9280afdddbd69575967dcab27a2354.r32.cf2.rackcdn.co...

2 downloads 187 Views 37KB Size

10680 Treena Street  5th Floor  San Diego, CA 92131 Pharmacy Help Desk 800.788.2949

DATE:

July 31, 2012

TO:

Third Party/Pharmacy

FROM:

Claim Adjustment Team MedImpact Healthcare Systems

PHONE:

(858) 790-6141

Subject: Pharmacy Attestation Process

The purpose of this communication is to review MedImpact’s processes for prescriptions dispensed by Long Term Care (LTC) pharmacies or dispensed in a Long Term Care setting for Part D beneficiaries who have had a change in their Low Income Subsidy (LIS) status. When a Part D beneficiary has been overcharged copayments due to incorrect LIS information for the beneficiary, CMS requires that Part D plan sponsors determine if the refund is owed to the beneficiary (pharmacy charged the copay to the beneficiary) or if the refund is owed to the pharmacy (pharmacy waived the copay). MedImpact has a number of options in place that provides the pharmacy an opportunity to attest to whether the copay has been charged or waived. We would like to review these options at this time and also introduce an additional option that we hope will streamline the process for pharmacies that wish to take advantage of this new opt-out feature. 1. PA4 The pharmacy can provide attestation during claim submission by submitting a Prior Authorization (PA) Type code of “4” on the claim (indicating they are not collecting a copayment from the beneficiary). Any refunds due would be released to the pharmacy. 2. Pharmacy Attestation Process a. The pharmacy is contacted by MedImpact and asked to complete and submit the “MedImpact Copay Waived Attestation Statement” indicating on the attached list of claims if they waived the beneficiary copay, are holding an outstanding debt for the beneficiary, or if the copay was collected. This information is provided to the pharmacy via fax, secured e-mail, or CD. b. MedImpact processes and documents returned attestation forms daily. c. Pharmacies are asked to respond to the MedImpact Copay Waived Attestation Statement within 2 weeks. If no response is received, MedImpact will release the payment to the beneficiary. d. Based on the responses received, MedImpact will process and release for payment all pended adjustment claims in the next EOB cycle to either the pharmacy or the beneficiary. e. If the pharmacy indicates that payment has been made by a third party, MedImpact will release payment to the pharmacy and it is the pharmacy’s responsibility to reimburse the third party. Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without prior authorization.

10680 Treena Street  5th Floor  San Diego, CA 92131 Pharmacy Help Desk 800.788.2949

3. Never Waive Opt-Out Some pharmacies have a policy to never waive copays. For these pharmacies, MedImpact provides the option of signing a certification indicating that the pharmacy does not waive copays and that any reimbursements of copay amounts should be made directly to beneficiaries. Upon receipt of the certification, MedImpact will no longer send the pharmacy attestation forms or request the pharmacy to review claims for copay payment disposition. MedImpact requests recertification on an annual basis. MedImpact is pleased to announce the addition of a fourth option for pharmacies that always waive copayments to opt out of the Pharmacy Attestation Process. 4. Always Waive Opt-Out Some pharmacies recognize that dual-eligible institutionalized beneficiaries should not be assessed copayments and always waive copayment amounts when applied. MedImpact is introducing a new opt-out option for these pharmacies. By signing a certification indicating that the pharmacy always waives copays, MedImpact will no longer send the pharmacy attestation forms or request the pharmacy to review claims for copay payment disposition. Reimbursements of copay amounts will be released directly to the pharmacy. MedImpact will request recertification on an annual basis.

If you would like to receive additional information on how your pharmacy can opt out of the Pharmacy Attestation Process or would like to receive a certification form for either of the opt-out options, please contact MedImpact’s Claim Adjustment Team (CAT) at 1-858-790-6141 or [email protected].  

Thank you.

Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without prior authorization.