PACE
2008 Part D Partner Plan List
Update
To ensure that the correct Part D plan is being
billed as the primary, PACE/PACENET is providing this revised cumulative list
(enclosed) of all cardholders currently enrolled in the selected Medicare Part
D plans who frequent your pharmacy. This list contains the cardholder’s name, PACE/PACENET
card number, HICN (Health Insurance Claim Number) the Medicare Part D Partner’s
name, BIN and PCN, the member’s ID number and group.
BEGINNING MONDAY
MARCH 31, 2008, PROVIDERS SUBMITTING CLAIMS CONTAINING INCORRECT PART D PARTNER
PLANS’ BIN NUMBER WILL HAVE THE CLAIMS DENIED WITH NCPDP REJECT CODE “7C” MISSING
/ INVALID OTHER PAYER ID AND NCPDP REJECT CODE “41”, “BILL CLAIM TO PRIMARY PAYER.”
- These denials will be
accompanied by the primary plan’s name, the BIN number and PCN in response
field 504-F4. The Member’s
ID will also be returned.
- Providers should ask PACE/PACENET
cardholders for their PART D information to verify if they have entered
into a new plan and to obtain their plan identification number.
- Although all 5
partner plans have a $275 deductible, each plan must be billed to ensure
that the claim amount is recorded for the TrOOP (True Out Of
Pocket expense.) Failure to bill the primary plan will result in
the cardholder not having the cardholder’s TrOOP accurately calculated.
- PACE/PACENET is also
requesting that providers continue to bill PACE/PACENET even in those
instances when the primary copay is equal to or less than the PACE or
PACENET copay. This request is made to insure that the cardholder’s TrOOP
is being accurately recorded.
- Providers
submitting invalid Other Coverage Codes (OCC’s) and/or deny reasons to
have the Program reimburse for the claim could have these payments
disallowed on audit.
- PACE/PACENET
cardholders are continually enrolling in Part D plans; therefore, this
list cannot be all inclusive. Providers should continue to inquire if a PACE/PACENET
cardholder has a Medicare Part D card.
Questions may be directed to Provider Services at
1-800-835-4080.