PACE

PROVIDER BULLETIN

June 16, 2006

 

MEDICARE DISCOUNT CARDS

and

OTHER COVERAGE CODES

 

 

The First Health Medicare Discount Card Program (MDP) ended on May 15, 2006. Claims filled on, or before, May 15th may still be submitted to First Health MDP; claims filled after May 15th are not eligible for reimbursement.

 

PACE continues to see claims submitted with Other Coverage Codes (OCC) of “03” Other Coverage Exists – claim not covered or “04” Other Coverage Exists – payment not collected, for cardholders whose MDP card coverage has terminated and whose file lists no other prescription coverage.

 

Claims submitted with an OCC of 03 without a reject reason and the BIN of the primary payer will deny effective June 20, 2006.

 

Claims incorrectly submitted with an OCC of 04 will circumvent the Other Coverage edit resulting in erroneous reimbursements. 

 

It is suggested that providers review the accuracy of the Other Coverage Code field to insure correct values are being submitted to the Program.

 

Providers may wish to contact their software vendors to assure themselves they are prepared for the June 20, 2006 edit implementation. 

 

Questions may be directed to Provider Services at:

1-800-835-4080