IMPORTANT INFORMATION
for
Providers submitting claims to
PACE, CRDP and SPBP
Highmark’s Medicare
Part D
BlueRx Prescription
Program
February 8, 2007
The PACE Program is supplying the enclosed list of
cardholders enrolled in Highmark’s Medicare Part D BlueRx group plan to assist
Providers in billing Highmark.
Please use this list to verify the cardholder’s Highmark ID
number and plan group name against your current file information. The PACE/Highmark Void Project has shown
that many providers are billing Highmark MEDIGAP plans instead of Highmark’s
Medicare Part D plan.
You may be unaware this is occurring because your software
may not identify which Highmark plan is being billed. However, the claim may be submitted to a Highmark MEDIGAP plan in
error. MEDIGAP plans return either a 100% co-pay or a percentage co-pay which
represents a discounted amount to be collected from the cardholder. This can be different from the member’s
co-pay under BlueRx.
Note that cardholders identified by Highmark as having both MEDIGAP
and Part D coverage are identified on this report with 2 asterisks (**).
Please bill Highmark’s Medicare Part D BlueRx, not their
MEDIGAP plan for prescriptions. In
order to do so, use the umbrella group number of SPBLUE2 and the Highmark
BlueRx ID.
Questions may be directed to
Provider Services at
1-800-835-4080