PACE

PROVIDER BULLETIN

May 5, 2006

SECURITY BLUE and FREEDOM BLUE

PRESCRIPTION PLANS

 

PACE has been advised that EFFECTIVE JANUARY 1, 2006, Cardholders having either Security Blue® or Freedom Blue® health plans as their primary payer AND who have any oral pharmaceutical prescribed that previously was billable to Medicare part B either through a PACE  Pharmacy  or  Dispensing Physician provider MUST now use Security and Freedom Blues’ provider –Medmark.®

 

NOTE: For PACE cardholders in need of injectable chemotherapy antineoplastics, providers may still request a medical exception until a determination can be made regarding the appropriate billing entity.

 

PACE providers may wish to direct Security Blue® or Freedom Blue® cardholders to call Medmark® at 1-888-347-3416 for further information.

 

Inhalation solutions for these cardholders must be billed to a Security Blue® or Freedom Blue® DMERC provider. To find a local DMERC provider, access Highmark’s website, www.highmark.com, click on Highmark® Blue Cross, Blue Shield and go to “Providers” in the lower right hand corner. This link will take you to Highmark’s Resource center where the “Healthcare Directory” can be used to obtain the appropriate DMERC provider in your area.

 

Providers with Security Blue® or Freedom Blue® cardholders who had Medicare Part B  claims reimbursed by PACE at 20% and received a denial from Medicare should contact either Security Blue® or Freedom Blue® to seek the remaining payment.

 

PACE CAN NOT reimburse PACE providers for Security Blue® or Freedom Blue® Medicare Part B claims.

 

Questions should be directed to Provider Services at

1-800-835-4080.