RE: Government Coordination of Benefits (COB)

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June 6, 2013

Dear Pharmacy Provider:

RE: Government Coordination of Benefits (COB) In order to comply with California Regulation 22 CA ADC sub. 50761 as it relates to Other Health Care Coverage, effective 6/4/13, pharmacies processing claims for CalOptima members will need to start submitting Coordination of Benefits (COB) claims using option 3 Government or Full disclosure COB. The payer sheet for CalOptima has also been updated to reflect this change.

Effective June 11, 2013 CalOptima is always payer of last resort according to Title 22, California Code of Regulations, Division 3, Subdivision 1, Chapter 2, Article 15, §50761. If a CalOptima Member has one or more other payers, any claim must be submitted to the primary and/or secondary payer(s) first before submitting to CalOptima for reimbursement. As payer of last resort, CalOptima shall verify that all prior payers have been considered based on the information submitted with the billing transaction. Please note that this applies to ONLY BIN: 600428 PCN: 05720000 To access the payer sheet, please go to: http://www.performrx.com/documents/pharmacy_payer_sheets/CalOptima_MediCal_0572_D.O.PDF If you have any issues with processing claims, please contact the PerformRx Pharmacy Services department at 1-888-962-3100. Thank you, Pharmacy Network Administration PerformRx

Next Generation Pharmacy Benefits

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