PACE

Provider Bulletin

May 15, 2009

Claim Reversal Specification Revision

 

 

PACE receives approximately 20,000 voids weekly. To insure that  the PART D TrOOP (True Out Of Pocket) expenses,  is calculated correctly, effective Tuesday, June 16, 2009,  ALL voids / reversals for ALL Programs  must include  the cardholder’s Program specific identification number.

 

Reversals submitted without the cardholder’s ID number will deny.

 

Although these revised specifications have been e-mailed to the vendor’s e-mail address you supplied, you may wish to contact your vendor to ensure that your system will accommodate this change by June 16, 2009.

 

 

 

INSURANCE SEGMENT

 

Segment MANDATORY for these transactions: E1, B1, B2, and B3.

Field

Field Name

VALUES

USED=Y

EDITED=E

PACE VALUES SUPPORTED

COMMENTS

111-AM

SEGMENT IDENTIFICATION

Ø4

E

Insurance Segment

*3Ø2-C2

CARDHOLDER ID

Use program specific ID.

E

SWIF Providers: Enter the SWIF cardholder’s claim reference number in this field.

3Ø1-C1

 

GROUP ID

PACE

CRDP

SPBP

CF

SB

MSUD

PKU

PAP

SWIF

 

E

PACE  = PACE / PACENET

CRDP  = Chronic Renal Disease Program

SPBP   = Special Pharmaceutical Benefits Program

CF       = Cystic Fibrosis

SB       = Spina Bifida

MSUD = Maple Syrup Urine Disease

PKU    = Phenylketonuria

PAP     =PA Patient Assistance Program

SWIF  = State Worker’s Insurance Fund

 

 

 

 

 

 

 

* New Field

 

 

 

 

 

Questions should be directed to Provider Services at 1-800-835-4080.