PRIMARY PAYER EDITS
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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;
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.