PACE

Provider Bulletin

July 1, 2009

 

MemberHealth CCRX and First Health Premier Claim Submissions

 

Enclosed is a list of cardholders that frequent your pharmacy and are enrolled in either MemberHealth CCRX or First Heath Premier Part D Plans. This list contains the correct BIN, PCN, Member ID and Group for each member and is a duplicate of the list sent in early January.

 

NOTE: If your pharmacy incorrectly billed PACE for cardholders enrolled in First Health Premier from January 1 through June 30, 2009, a list of those incorrectly submitted claims is also included.

 

PACE is re-issuing this cardholder list because paid history contains many claims that have been submitted to PACE incorrectly. Claims have been paid by PACE after being rejected by MemberHealth or First Health for either an Invalid Group (NCPDP error 51) or Invalid Cardholder ID (NCPDP error 52).

 

To insure that the primary payer is being billed appropriately, PACE is re-sending this membership information to your pharmacy. We urge you to review this data to insure that the primary payer information in your system is correct.

 

Since PACE has paid claims as the primary, not the secondary payer, all pharmacies that submitted claims to PACE with NCPDP error 52 for these two plans from January 1, through June 30, 2009, are being requested to void and resubmit these claims correctly. Affected pharmacies will receive fax notification the week of July 6th from MemberHealth CCRX. At the time of this mailing, it was anticipated that First Health Premier would also supply this information to the pharmacies in the same manner. In the event that this does not occur, PACE has produced this list of First Health Premier claims that providers are to void from the PACE system.

 

Beginning July 13, though and including, July 16, the claims window to accomplish this on-line processing will be open. Providers should submit these claims to First Health Premier as the primary, then to PACE as the secondary payer.

 

Note: Only those pharmacies that billed First Health Premier incorrectly have a claims list included with this bulletin. Similarly, only those who billed MemberHealth incorrectly will be notified by fax.

 

Providers continuing to submit this incorrect member information to the primary payer resulting in denied claims and subsequent overpayment by PACE will have these claims disallowed in post payment reviews. 

 

 

 

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