PACE

 Provider Bulletin

Highmark Blue RX Basic Medicare Part D

VOIDED CLAIMS

January 26, 2007

 

 

Eighty percent (80%) of providers received Highmark Void reports the week of January 21st.      These reports identified voids that would appear on the Remittance Advice dated February 2, 2007.

 

The Program is reviewing these voided claims. The voids that were originally scheduled to appear on the R/A of February 2nd have been delayed and will not appear until the Remittance Advice of February 9, 2007.

 

MEDCO is in the process of reprogramming their Point of Sale system to permit those voided claims appearing  on the PACE report that have dispensing dates of exceeding 90 days but less than 180 days from the date of service to be accepted. This reprogramming is anticipated to be completed by MEDCO by late February.

 

At that time Providers will have the option to re-bill the voided claims that exceed 90 but are less than 180 days from the date of service days either through the MEDCO website or through the Point of Sale system.

 

Providers choosing to use MEDCO’s website will receive a 10 page instruction booklet further explaining the process outlined in the PACE bulletin that accompanied the Highmark Void Report. This booklet will be included in the PACE Remittance Advice of February 2, 2007.

 

IMPORTANT: The Program is finding that many claims appearing on the Highmark Void Report as having been billed to PACE with an Other Coverage Code  (OCC)  of  “04” were billed by the Provider to a Highmark Medigap plan. The Highmark Medigap plan DOES NOT pay for pharmaceuticals, it only returns a discounted price to be charged to the cardholder.

 

These claims need to be billed to the member’s HIGHMARK Part D plan.

 

Please call PACE Provider Services at 1-800-835-4080 PACE; Cardholder Services at 1-800-225-7223 or ask the cardholder for his/her Highmark Part D card to get the correct numbers for submission.