PACE

Provider Bulletin

January 27,  2006

 

DATE PRESCRIPTION WRITTEN EDIT

 

A CD containing the revised PACE Provider Manual and revised NCPDP v5.1 Payer Specifications is currently being prepared for distribution.  The revised specifications contain the following fields that will be edited effective February 28, 2006:

 

PATIENT SEGMENT

 

      Field 305-C5,  Patient Gender Code.

Use numerical values of 1= male; 2 = female. Zeros will deny.

Field 310-CA,  Patient First Name.

              The Program will edit the first 2 characters.

Field 311-CB, Patient Last Name.

              The Program will edit the first 3 characters.

 

PRESCRIBER SEGMENT

 

      Field 427-DR, Prescriber Last Name.

The Program will conduct a comparison with the prescriber file.

 

CLAIM SEGMENT

 

Field 414-DE, Date Prescription Written.

 

Effective February 28, 2006, the Date the Prescription is written will be compared against the “Date of Service” on both original and refilled prescriptions.  Original or refill prescriptions whose date of service exceeds 6 months from the date the prescription was written will deny with an NCPDP Error M4, PACE Error 724, “Prescription Time Limit Exceeded.”

 

Providers wishing to view these documents prior to distribution of the CD should go to the Department of Aging’s website at www.Aging.State.PA.US . Use the PACE and PACENET “Quicklink” to PACE/PACENET Reports & Publications. Access PACE/PACENET Pharmacy Provider Program Manual to view both the revised manual and v5.1 NCPDP specifications.

 

Questions may be directed to PACE Provider Services at

 

1-800-835-4080.