PACE

PROVIDER BULLETIN

April 25, 2008

Important Information

 

Prescriber NPI: On May 23, 2008,  many primary prescription plans will accept only the prescriber’s NPI in Field 411-DB. PACE/PACENET, CRDP, SPBP and other programs administered by the Department of Aging will accept either the prescriber’s NPI or his/her Pennsylvania state license number. To avoid a denied claim, the correct Prescriber ID Qualifier must be entered in field 466-EZ. The Pennsylvania state license number qualifier is “13”; the NPI qualifier is “1”.

 

When PACE/PACENET, CRDP, SPBP and the other programs are the secondary payers, providers may continue to follow the primary plan’s rules. PACE  will continue to accept  the prescriber’s DEA, NPI or PA state license number if the correct presciber ID qualifier is entered in field 466-EZ

 

Paper Remittance Advice (R/A): The Program is currently developing a web-based Remittance Advice. This electronic R/A will be available to all providers currently receiving paper R/A’s. More information will be forthcoming in the next few weeks.

 

Website: By early summer, the Commonwealth will make available a website enabling consumers to survey medication pricing at pharmacies nearest their home. It is anticipated that this website will be used mainly by Pennsylvanians without prescription drug coverage or by people who have coverage with high cost sharing who are seeking to spend their health care dollar wisely.

 

PACE and Medicare Part D: The Department has again stepped up its effort to ensure that PACE, SPBP and CRDP are truly the payer of last resort.  Cardholders identified on the Department’s files as having other prescription coverage must have the primary payer billed first. 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.

 

 

Questions may be directed to Provider Services at

1-800-835-4080