February 13, 2004
PACENET MONTHLY DEDUCTIBLE:
New PACENET legislation changed the annual deductible into a rolling cumulative amount. That is, the annual deductible was divided into 12 monthly accumulating deductibles of $40.00.
The deductible period begins on the first day of the month and ends on the last day. A PACENET cardholder’s deductible period begins the month his/her PACENET eligibility begins.
PACE providers have been required to submit claims on-line prior to dispensing the medication since 1991. Until January 1, 2004, however, the Program permitted original claims to be billed up to 90 days from the date of service of the claim. Effective January 1, 2004 the submission time for original claims submission was reduced to 30 days. The 30-day submission time for original claims still allows for software interruptions or processing anomalies.
NOTE: Providers can use the NCPDP re-bill transaction (Transaction B3) to re-bill claims up to 90 days from the date of service. The re-bill transaction accesses the previously adjudicated claim and permits the provider to modify the earlier submission in one transaction.
Providers voiding a claim (B2 transaction) over 30 days from the service date, then submitting it again (B1 transaction) will have the claim denied. B1 transactions identify the submission as an original claim. Original claims must be received within 30 days from the date of service.
Questions may be directed to Provider Services at 1-800-835-4080.