PACE PROCESSING OF MDP CLAIMS

MDP claims submitted to PACE must contain the correct amount in the PATIENT PAID AMOUNT SUBMITTED FIELD --Field 433-DX-- to be adjudicated correctly.

The comment section of Field 433-DX of the Program’s NCPDP v5.1 specifications state, “DO NOT ENTER PACE/PACENET COPAY IN THIS FIELD.”

Field 433-DX is to contain the amount indicated by the MDP plan that the patient is to pay.

· During the TA credit, the Patient Paid Amount Submitted will be 5% or 10% of the Amount allowed by the MDP Program.

· After the $600 TA amount is depleted, Providers choosing to continue submitting to MDP as the primary payer should have the MDP’s discounted price populate the Patient Paid Amount Submitted field.

Providers submitting claims with the PACE copay in this field should review their submission procedures to correct this error.

PACE will review incorrectly submitted claims and will adjust providers future payments to correct any PACE miscalculated payments.

Questions may be directed to Provider Services at

1-800-835-4080.

PPB-04-015