REMINDER: Express Scripts Migrating Plan Sponsors

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Express Communications August 22, 2012 Page 1 of 3

REMINDER: Scripts Migrating Plan Sponsors Sept. 1 Page 1 ofExpress 3 Announcement:

Effective September 1, 2012, a second group of Express Scripts’ COMMERCIAL PLAN SPONSORS will be migrated to the new adjudication system of the combined company. As a reminder, below is the list of plan sponsors migrating September 1. Please process claims for transitioning members using the processing information indicated on the member ID cards. (The BINs and PCNs will not change.)

Plan Sponsor Information:

Client Name Societá Italiana Di Mutua New Orleans Cold Storage* Northwestern Industries, Inc. Excess Risk Reinsurance* San Joaquin Valley Hotel & Restaurant – Local 62 International Brotherhood of Boilermakers Geneva Woods Pharmacy IRC-CMMIC 721 H&W Trust Fund Robins Federal Credit Union United Brotherhood of All Trades

RxGroup BX2A DU6A DUYA DVKA

State(s) San Francisco, CA area New Orleans, LA Seattle, WA MS

JOAA

North Central CA

JPBA V2WA Z2RA Z9UA BHDA

Kansas City metro area Anchorage, AK Los Angeles, CA area GA NJ

* Client termed in June, but is included on this list in the event of claim reversals.

We included the updated Express Scripts Commercial Payer Sheet with our previous communication, and it is available on the Express Scripts’ web portal at www.expressscripts.com/corporate. Please also refer to the updated FAQs beginning on page 2 of this communication. Information for Pharmacies:

Please reprogram your systems without further delay to populate the additional REQUIRED fields on the updated payer sheet with the appropriate valid values as listed, for both Inbound Billing and Reversal Transactions. Your system should also be programmed to receive the additional fields in the Outbound Billing Response since ESI did not previously return these fields. Please be reminded that Express Scripts BINS and PCNs are not changing for ESI clients, and legacy Medco payer sheets have not changed. Values submitted for all fields are validated against the NCPDP External Code List (ECL). Pharmacies may experience a standard NCPDP reject if a VALID ECL value is not entered.

Pharmacy Portal:

When the Express Scripts plan sponsors listed above transition to the combined adjudication system on September 1, their members’ claims will no longer be visible on the Express Scripts pharmacy portal. (For now, claims for all Express Scripts members that have NOT migrated continue to be accessible on the Express Scripts pharmacy portal.)

For More Information:

If you need assistance with processing a claim, please call the number listed on the back of the member’s prescription drug ID card.

Confidential & Proprietary

© 2012 Express Scripts Holding Company. All Rights Reserved.

August 22, 2012 Page 3 of 4

Frequently Asked Questions for Pharmacies Q. Are the Express Scripts plan sponsors listed in this communication moving to the Medco adjudication platform? Express Scripts is combining the best technology from both legacy companies to create a “new” upgraded adjudication platform for the combined company. This will not only “upgrade” the member experience but will ultimately enhance the adjudication process for network providers as well. Q. Is the Commercial Payer Sheet we received earlier this month final? It is the final Commercial Payer Sheet until further notice, but there may be additional changes as the integration progresses. Q. Do the Commercial Payer Sheet changes apply to all ESI-supported BINs or just 003858? The attached payer sheet applies to ALL Express Scripts commercial plans, including the following BIN numbers: BIN ØØ3858 61Ø575 Ø1355Ø 61ØØ53

Description Express Scripts WellPoint Commercial WellPoint Commercial WellPoint Commercial

BIN Ø1Ø991 Ø13865 4ØØØ23 Ø1ØØ33

Description Emblem – Teamsters Local 237 Emblem – GHI Commercial Emblem – HIP Commercial Emblem – Vytra Health Plan

Q. Does the updated payer sheet apply to all Express Scripts commercial plan sponsors or only to those that have been migrated to the new adjudication platform? The updated payer sheet applies to ALL Express Scripts commercial plan sponsors. You do not need to differentiate between plan sponsors migrated to the new adjudication platform and those that remain on the existing ESI platform. The changes will be accommodated on both the new platform and the legacy ESI platform. Q. Will I receive plan information for PAID claims in field 3Ø1-C1 (Group ID) and field 524-FO (Plan ID)? No. You will receive plan information in only one of these fields. Express Scripts is moving to field 3Ø1-C1 (Group ID) to return plan information for PAID claims. For those clients migrating to the new platform, plan information will be returned in the Group ID field. Until clients migrate to the new ESI platform, plan information will continue to be returned in field 524-FO (Plan ID). Q. If a claim is submitted to an Express Scripts BIN, will the Medco website address be returned on the rejected response? Yes, the Medco web address will be returned for migrated plan sponsor claims ONLY. Q. Why am I receiving an „E2‟ reject code (M/I Route of Administration)? Express Scripts now validates all submitted values against standard NCPDP External Code List (ECL) values. This includes validation of SNOMED codes submitted in field 995-E2 (Route of Administration). Q. Why am I receiving a „DN‟ reject response for field 423-DN (Basis of Cost Determination)? While Express Scripts previously indicated field 423-DN as a required field on its payer sheet, the new platform has an edit in place to reject the claim if this field is not populated, or is populated with an invalid NCPDP value. Q. The segment “Reversals: COB/Other Payments Segment – Situational” has been added to the Commercial Payer Sheet for reversal transactions, and fields 337-4C (Coordination of Benefits/Other Payments Count) and 338-5C (Other Payer Coverage Type) must be sent for all COB claim reversals. Will Express Scripts accept these fields both for claims that have NOT migrated as well as for those that have migrated? Yes. The claim will reverse on both systems when these COB fields are submitted.

© 2012 Express Scripts Holding Company. All Rights Reserved.

August 22, 2012 Page 4 of 4

Frequently Asked Questions for Pharmacies (Continued) Q. Submission Clarification codes are now accepted in field 420-DK (Submission Clarification Code) of the Claim Segment to override certain rejections as outlined below: Reject Code 88 79

Reject Description DUR REJECT ERROR MX DOSE/DAY= xx OVR/DR APV Refill Too Soon

Submission Clarification Code 02 = Other Override 03 = Vacation Supply 04 = Lost Prescription 05 = Therapy Change

If the pharmacy enters the codes in field 420-DK, does this mean they would not need to call the Pharmacy Help Desk and will replace the need to manually issue overrides for these rejections? Yes. The pharmacy can enter these codes without calling the Help Desk for claims processed on the new platform. Q. What will happen to all other DUR alerts we currently receive (e.g. TD-Therapeutic Duplication, PG Pregnancy, Age) when plan sponsor claims are migrated? Most of the DUR alerts, including therapy duplication, pregnancy, age, low dose, will generate a warning at point-of-sale. Most drug-drug interactions and high dose alerts will continue to reject. Ingredient duplications check will continue to be performed, but will now be incorporated into Therapy Duplication checks. Q. If I have questions regarding submission of a claim, what number should I call? Claims submitted prior to September 1, 2012 for the migrated members indicated on page 1 of this communication will no longer be viewable on the Express Scripts pharmacy portal. If you have questions or need assistance processing one of these claims, please call the pharmacy help desk number indicated on the back of the member’s prescription drug ID card. For assistance with claims submitted on or after September 1, 2012, please access the legacy Medco Pharmacy Resource Center web portal at www.medco.com/rph. Q. Will my remittance change with this plan sponsor upgrade? If so, how? Pharmacies that submit claims for the Express Scripts’ plan sponsors that have been transitioned will be reimbursed for those claims with their legacy Medco remittance. As the integration progresses and more plan sponsors are upgraded, providers may receive multiple remittances. We will keep you informed by communicating any changes in advance. Q. How will I be reimbursed for Professional Service Fees (PSFs) on migrated vaccine and compound claims? For migrated claims identified as vaccines or compounds, your PSF reimbursement will appear as line item CREDIT adjustments on your legacy ESI remittance. As noted above, however, your reimbursement for migrated claims will appear on your legacy Medco remittance. To ensure appropriate reimbursement for migrated compound claims, please continue to submit Level of Effort (LOE) information. We will advise you when the remittance will be updated to include the PSF reimbursement (along with the claim reimbursement) for migrated members. Q. On which remittance will transaction fees be deducted for upgraded claims? All transaction fees for claims processed, regardless of whether or not the plan sponsor has been transitioned, will be deducted from your legacy Express Scripts remittance. For migrated members, the transaction fee will appear as a line item debit on the legacy Express Scripts remittance. NOTE: Remittance changes impacting migrated compound claims, vaccine claims and transaction fees will appear 14 days after submission of the claim at p-o-s. This is an interim solution as we combine companies, and we will advise you of future changes. Q. Will I be able to access claims on the Express Scripts‟ pharmacy portal for upgraded members? No. Beginning September 1, 2012, migrated member claims will no longer be viewable on the Express Scripts pharmacy portal. However, messaging on the portal will direct providers in how to access the correct information.

© 2012 Express Scripts Holding Company. All Rights Reserved.