PACE

PROVIDER BULLETIN

MARCH 28, 2008

PRIMARY PAYER EDITS

 

Effective Monday, March 31, 2008, PACE/PACENET is implementing edits to insure providers bill the correct PACE Medicare Part D partner plan as the primary payer.

 

Lists were sent on March 5, 2008, to all PACE providers identifying those cardholders in the five (5) PACE Part D partner plans. These lists contained all the necessary information to update cardholder files and bill the correct Part D plan.

 

Claims billed to either the incorrect Medicare Part D primary payer or to no Medicare Part D primary payer when one is on file, will deny for the following NCPDP Errors:

 

7C Missing / Invalid Other Payer ID;

and/or

41 Submit Claim to Primary Payer

 

In the response field 504-F4, the correct primary plan’s name, BIN number, PCN, and Member’s ID is returned. Using this information, providers must bill the correct Medicare Part D Plan as the primary payer.

 

 

IMPORTANT: Beginning Monday March 31st, Providers calling PACE Provider Services at 1-800-835-4080 should listen closely to the option announcement. The option selection criteria will have changed.