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.