PACE

PROVIDER BULLETIN

January 28, 2005

 

MDP Transitional Assistance (T/A)

 

The  2005 $600 T/A benefit for Medicare Discount Program (MDP) cardholders began January 1, 2005.

 

MDP cardholders were NOT sent new MDP cards.  Cardholders receiving a MDP card in 2004 continue to have MDP coverage in 2005 with another $600 TA benefit.

 

MDP cardholders who did not exhaust their $600 T/A benefit  for 2004 will carry the remainder  into 2005.

 

IMPORTANT:  Providers PLEASE review your PACE/MDP submissions for 2005 to insure that your system is not continuing to bill PACE as the primary payer for those PACE/MDP cardholders who exhausted their 2004 $600 T/A Benefit.

 

Claims for PACE and PACENET cardholders enrolled in the First Health Medicare Discount Drug Program will receive the response of $0.00 due from the PACE and PACENET cardholder until their MDP benefit is exhausted if the claim is billed as follows:

 

·         a “2” is entered in the Other Coverage Code Field (NCPDP 308-C8.)

  The other coverage code is to remain “2” until the cardholder’s MDP  benefit for 2004 and 2005 is exhausted or the claim is rejected by MDP as not being  compensable.

Providers should not enter a “3” or “4” in the other coverage field unless the MDP response indicates the claim is not covered (3) or the MDP benefit is exhausted (4).

Claims submitted with a “3” or “4” in the Other Coverage field are returned with a PACE/PACENET copay even though the cardholder’s MDP account may not be exhausted.  

 

·         the BIN of “011487” for First Health Medicare Discount Drug Cardholders is entered in “Other Payer ID” field (NCPDP 340-7C.)

 

·         the dollar amount paid by MDP is entered in the “Other Payer Amount Paid” field (NCPDP 431-DV.)

 

·         the copay indicated by the MDP Card should be entered in the “Patient Pay Amount” field (NCPDP 433-DX.)

 

PACE billing questions may be directed to PACE Provider Services at:

 1-800-835-4080.

 

MDP billing questions may be directed to MDP Provider Services at:

 1-800-774-9412.

PPB-05-001