PACE

Provider Bulletin

November 4, 2005

PAYOR SPECIFICATIONS NCPDP v5.1

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