PACE

PROVIDER BULLETIN

February 17, 2006

MEDICARE PART D PRESCRIPTIONS

and

OTHER COVERAGE CODES

Beginning January 1, 2006, many PACE/PACENET Cardholders:

• Have enrolled themselves into Part D prescription plans.
• Have been enrolled by their Medical Insurance providers into Part D prescription plans.
• Have been, and continue to be, enrolled by CMS in Part D plans if they qualify for the low income subsidy.

Eventually virtually all PACE/PACENET cardholders will have both a PACE/PACENET card and a Medicare Part D plan card.

As enrollment in Part D plans continue, Providers should continue to ask Cardholders if they have a Part D plan. Providers must bill these Medicare Part D plans before billing PACE/PACENET.

If a claim is submitted to PACE/PACENET with an:

• Other Coverage Code of “03” Other Coverage Exists –claim not covered;
• Other Coverage Code of “04” Other Coverage Exists –payment not collected;
• Other Coverage Code of “05” Managed care plan denial;
• Other Coverage Code of “06” Other Coverage Exists –payment denied-- not a participating provider;
• Other Coverage Code of “07” Other Coverage Exists –not in effect on date of service,

Providers must be able to verify the accuracy of this other coverage code on audit.

Failure to substantiate the validity of the submitted code will result in the disallowance of the claim.

Questions may be directed to Provider Services at:

1-800-835-4080