PACE

 Provider Bulletin

Highmark Blue RX Basic Medicare Part D

VOIDED CLAIMS

February 26, 2007

 

The enclosed PACE report contains voided claims that will appear on the PACE Remittance Advice of March 16, 2007.

 

Some CMS excluded products were inadvertently included in the original project; therefore, this revision may contain fewer claims. The remaining voids are for those claims that should have been billed to Highmark Blue Rx Basic as the primary payer. Also claims have been voided when information from Highmark identified incorrect amounts submitted in either the amount of Highmark’s patient copay or Highmark’s payment to the pharmacy.

 

Important: The voids appearing on this revision, as well as the original version sent January 19, 2007, contain only those claims received by Highmark through mid-November, 2006.  Providers are responsible for reviewing and correcting, if necessary, ALL claims for these cardholders to avoid potential audit disallowance.

 

On March 6, 2007, providers will be able to submit Medicare Part D claims older than 90 days using Medco’s point-of-sale system.  Claims with dates of service of September 1, 2006 and beyond for Highmark’s Medigap & Medicare Part D programs will be eligible for reversal and re-submission by Medco’s point-of-sale system up to the close of business, Saturday, March 24, 2007.  Specific instructions on how to handle these claims are forthcoming from Medco.

 

These claims may be re-submitted to Highmark as the primary payer.  To reprocess the claims, providers will need to submit claims through BIN number 610014.

 

If Providers submitting these claims to Medco receive a reject message of rejection 70 = Product/Service Not Covered or 75 = Prior Authorization Required with an alternate message of “TEMP FILL of 34 D/S ALLOW WITH PA/MC = 11111,” the Provider needs to resubmit the claim with a PA/MC code of 11111 in the Prior Authorization field (416-DG).  Be sure to review all messages since the rejection message may not appear on the first computer page.  If the claim continues to reject, and you are not able to resolve the rejection, contact the Medco Pharmacy Services Helpdesk at 1- 800-922-1557. 

To permit PACE to be billed as the secondary payer, the Program has also extended the on-line submission time for these claims up to close of business, Saturday, March 24, 2007.  This extension applies only to claims identifying Highmark as the primary payer.

 

Submission questions relating to PACE may be directed to PACE Provider Services at

 1-800-835-4080