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