PACE
Provider Bulletin
November
4, 2005
DECEMBER EDIT IMPLEMENTATION
The fields listed
below are contained in the current version of PACE/PACENET NCPDP v5.1 Payor
Specifications.
PACE identifies each paid claim with incorrect
data in these fields on the PACE Remittance Advice with E.O.B. Message Code 015—Missing/Invalid group name
and/or E.O.B. Message Code 012—Missing/Invalid Patient Location.
Claims currently paid and
accompanied with E.O.B.’s of 012 or 015 will deny December 1, 2005.
Providers
are urged to review their Remittance Advices carefully to avoid rejected
claims. Currently only 15% of independent
pharmacies are submitting these fields correctly. Compliance among chain
providers varies widely.
|
Field |
Field Name |
Comments |
|
307-C7 |
Patient
Location* |
0= Not Specified (This value will be denied as Invalid.) Required Values 1 =
Home
7 = Skilled Care Facility 2 =
Inter-Care
8 = Sub-Acute Care Facility 3 =
Nursing Home 9
= Acute Care Facility 4 =
LongTerm / Extended Care 10
= Outpatient 5 = Rest
Home 11
= Hospice 6 =
Boarding Home |
|
301-C1 |
Group ID |
Required Values PACE = PACE/PACENET CRDP = Chronic Renal Disease Program SPBP = Special Pharmaceutical Benefits Program CF = Cystic Fibrosis SB = Spina Bifida PKU = Phenylketonuria MSUD = Maple Syrup Urine Disease PAP =
Pennsylvania Patient Assistance Program SWIF= State Workers’ Insurance Fund |
*Patient Location Definitions listed
on back.
Questions may be directed to Provider Services at 1-800-835-4080.
(OVER)
PPB-05-022