PACE

 PROVIDER BULLETIN

October 3,  2008

PACE & E-PRESCRIBING

 

 

The number of prescribers and pharmacies utilizing e-prescribing continues to increase throughout Pennsylvania. To facilitate e-prescribing for cardholders, PACE will make eligibility data available for e-prescribing physicians beginning in November,

 

Recognizing that thousands of Pennsylvania pharmacies accept e-prescriptions, this bulletin is intended to address provider’s concerns when an e-prescription for a PACE cardholder is received.

 

The use of e-prescribing is to be in accordance with Chapter 27 of the Pennsylvania Code, §27.201 Electronically transmitted prescriptions.

 

However, to avoid PACE E-prescription auditing issues, providers are reminded that:

 

  • PACE requires that original prescriptions be retained for four (4) years at the principal place of business.

 

  • When PACE is the primary payer, claims submitted for A-Rated brands will deny unless PACE Provider Services has been contacted and a medical exception has been granted.  
    • A request for a “Brand Medically Necessary”  exception  will be considered for:

§         Prescription Origin Code 1 / DAW 1 -- Written prescriptions which contain “Brand Medically Necessary” in the prescriber’s own handwriting.

§         Prescription Origin Code 3 / DAW 1  -- Electronic or E-prescriptions in which the prescriber specifically directs the brand to be dispensed instead of the generic.

§         Prescription Origin Code 4 / DAW 1 -- Faxed (facsimile) of an original written prescription containing “Brand Medically Necessary” in the prescriber’s own handwriting.

 

Reminder:  Medical Exceptions are not permitted to be granted after the fact.

 

NOTE:       

·         Prescription Origin Code 0--Claims submitted with a 0 will deny.

·         Prescription Origin Code 2--Telephone prescriptions directing that the brand is

 “Medically Necessary” are not accepted for PACE medical exceptions for A-rated brands.

 

 

The prescriber will be contacted by the Program to document the clinical reason for the “Brand Medically Necessary” designation. Prescribers failing to respond or those supplying insufficient or unacceptable documentation will not have the Medical Exception authorization extended.   

 

 

 

Questions may be directed to Provider Services at:

1-800-835-4080