ADDITIONAL MESSAGE INFORMATION CONTINUITY. The following categories of members are exempt from co-pay: Effective July 1, 2022, the following changes occurred as it relates to family planning and family planning-related pharmacy benefits. State of New York, Howard A. Zucker, M.D., J.D. Programs for healthy children & families, including immunization, lead poisoning prevention, prenatal smoking cessation, and many others. BNR=Brand Name Required), claim will pay with DAW9. BIN - 610084 PCN - DRTXPROD GroupID - CSHCN . money from Medicare into the account. Medicaid Managed Care BIN, PCN, and Group 1/1/2019 through 12/31/2019 (pharmacy services carved out of managed care starting 1/1/2020) BIN 610011, PCN IRX, Group SHNNDMEDI If you have pharmacy questions, you may email them to dhsmed@nd.gov. This form or a prior authorization used by a health plan may be used. The PCN is defined by the PBM/processor as this identifier is unique to their business needs. Pharmacies are expected to keep records indicating when member counseling was not or could not be provided. Required when the patient meets the plan-funded assistance criteria, to reduce Patient Pay Amount (505-F5). 07 = Amount of Co-insurance (572-4U) This pharmacy billing manual explains many of the Colorado Department of Health Care Policy & Financing's (the Department) policies regarding billing, provider responsibilities, and program benefits. The "Dispense as Written (DAW) Override Codes" table describes valid scenarios allowable per DAW code. State Government websites value user privacy. Required if this field could result in contractually agreed upon payment. Effective as of July 1, 2021 NCPDP Telecommunication Standard Version D. NCPDP Data Dictionary Version Date August of 2007 NCPDP External Code List Version Date October 15, 2020 Contact/Information Source www.medimpact.com For DAW 8-generic not available in marketplace or DAW 9-plan prefers brand product, refer to the Colorado Pharmacy Billing Manual", Allowed by Prescriber but Plan Requests Brand. Pharmacies may submit claims electronically by obtaining a PAR from thePharmacy Support Center. Federal regulation requires that drug manufacturers sign a national rebate agreement with the Centers for Medicare and Medicaid Services (CMS) to participate in the state Medical Assistance Program. Required for partial fills. Plan PBM Phone BIN PCN Group OHA (Fee-for-Service or "Open Card") 888-202-2126 . The State Fiscal Year (SFY) 2021-22 enacted budget delays the transition of the Medicaid Pharmacy benefit to the Medicaid Fee-for-Service (FFS) Pharmacy Program by two years, until April 1, 2023. If there is more than a single payer, a D.0 electronic transaction must be submitted. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Provider Synergies, LLC is an affiliate of Magellan Medicaid Administration contracted with AHCCCS to facilitate and collect rebates for the supplemental rebate program. Effective February 25, 2017, pharmacies must code their systems using the D.0 Payer Sheets provided below when submitting pharmacy POS transactions to the Health First Colorado program for payment. A member has tried the generic equivalent but is unable to continue treatment on the generic drug and criteria is met for medication. Pharmacies must keep records of all claim submissions, denials, and related documentation until final resolution of the claim. These source documents, in addition to any work papers and records used to create electronic media claims, shall be retained by the provider for seven years and shall be made readily available and produced upon request of the Secretary of the Department of Health and Human Services, the Department, and the Medicaid Fraud Control Unit and their authorized agents. Information on the grant awarded for the State Innovation Model Proposal, Offers resources for agencies who operate the Weatherization Assistance Program in the state of Michigan. Interactive claim submission must comply with Colorado D.0 Requirements. false false Insertion sort: Split the input into item 1 (which might not be the smallest) and all the rest of the list. A pharmacist or pharmacist designee shall offer counseling regarding the drug therapy to each Health First Colorado member with a new or refill prescription if the pharmacist or pharmacist designee believes that it is in the best interest of the member. More detailed information is available and regularly updated on the Pharmacy Carve-Out web page. If a Medicaid member enters or leaves a nursing facility, the member may require a refill-too-soon override in order to receive his or her drugs. A PAR is only necessary if an ingredient in the compound is subject to prior authorization. The pharmacy must retain a record of the reversal on file in the pharmacy for audit purposes. Expanded Income and Title XIX (Fee-For-Service): Members with incomes up to 260% of the federal poverty level (expanded income) and in the Title XIX (Fee-For-Service) eligibility categories may receive up to a 12- month supply of contraceptives with a $0 co-pay. These medications (e.g., Paxlovid) still need to be billed to Colorado Medicaid, even though they are free of cost, and the claim requirements for billing free medications is outlined below: The Health First Colorado program uses the National Council on Prescription Drug Programs (NCPDP) electronic format and the Pharmacy Claim Form (PCF) to submit prescription drug claims. Pharmacies must complete third-party information on the PCF and submit documentation from the third-party payer of payment or lack of payment. If PAR is authorized, claim will pay with DAW1. We are an independent education, research, and technology company. Please contact the plan for further details. *Note: Code 09 is a negative amount and is not a valid option for field 351-NP. The Michigan Medicaid Health Plan Common Formulary can be found at Michigan.gov/MCOpharmacy. We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. A variety of reports & statistics for programs and services. 01 = Amount Applied to Periodic Deductible (517-FH), 02 = Amount Attributed to ProductSelection/Brand Drug (134-UK), 03 = Amount Attributed to Sales Tax(523-FN), 04 = Amount Exceeding Periodic Benefit Maximum (520-FK), 06 = Patient Pay Amount (Deductible) (505-F5), 08 = Amount Attributed to Product Selection/Non-preferred Formulary Selection(135-UM), 10 = Amount Attributed to Provider Network Selection (133-UJ), 11 = Amount Attributed to Product Selection/Brand Non-Preferred FormularySelection(136-UN), 12 = Amount Attributed to Coverage Gap (137-UP), 13 = Amount Attributed to Processor Fee (571-NZ), MA = Medication Administration - use for vaccine. If the medication is not on the family planning-related drug list, then the prescriber will need to complete a prior authorization to confirm that the drug was prescribed in relation to a family planning visit. Required if Basis of Cost Determination (432-DN) is submitted on billing. Dispensing (Incentive) Fee = Standard dispense fee based on a pharmacys total annual prescription volume will still apply. . All pharmacy PARs must be telephoned, faxed, or submitted via Real Time Prior Authorization via EHR, by the prescribing physician or physician's agent to the Pharmacy Benefit Manager Support Center. Bridge Card Participation Information on Electronic Benefits for clients and businesses, lists of participating retailers and ATMs, and QUEST. No products in the category are Medical Assistance Program benefits. Non-maintenance products submitted by a pharmacy for mail-order prescriptions will deny. All plans must at a minimum cover the drugs listed on the Medicaid Health Plan Common Formulary. Applicable co-pay is automatically deducted from the provider's payment during claims processing. Required if Other Payer ID (340-7C) is used. s.parentNode.insertBefore(gcse, s); Only members have the right to appeal a PAR decision. Required if Patient Pay Amount (505-F5) includes co-pay as patient financial responsibility. Program management through stakeholder collaboration, effective use of drug rebates and careful selection of drugs on a Preferred Drug List (PDL) are just three waysNC Medicaidprovides access to the right drugs at the most advantageous cost. Transaction Header Segment: Mandatory . Information on Safe Sleep for your baby, how to protect your baby's life. The Common Formulary applies to pharmacy claims paid by Medicaid Managed Care Organizations it will not apply to claims paid through Fee-for-Service. Prescription cough and cold products include non-controlled products and guaifenesin/codeine syrup formulations (i.e. Required if needed to identify the transaction. An additional request for reconsideration may be submitted within 60 days of the reconsideration denial if information can be corrected or if additional supporting information is available. A pharmacist shall not be required to counsel a member or caregiver when the member or caregiver refuses such consultation. Electronically mandated claims submitted on paper are processed, denied, and marked with the message "Electronic Filing Required.". Supplies listed in the Pharmacy Procedures and Supply Codes, such as enteral and parenteral nutrition, family planning and medical/surgical supplies are subject to the Pharmacy Carve-Out. Medicare MSA Plans do not cover prescription drugs. All electronic claims must be submitted through a pharmacy switch vendor. The North Carolina Medicaid Pharmacy Program offers a comprehensive prescription drug benefit, ensuring low-income North Carolinians have access to the medicine they need. The maternity cycle is the time period during the pregnancy and 365days' post-partum. On July 1, 2021, certain beneficiaries were enrolled in NC Medicaid Managed Care health plans, which will include the beneficiarys pharmacy benefits. An optional data element means that the user should be prompted for the field but does not have to enter a value. Note: The format for entering a date is different than the date format in the POS system ***. Sent when Other Health Insurance (OHI) is encountered during claim processing. Where should I send the Medicare Part D coordination of benefits (COB) claims? The BIN/IIN field will either be filled with the ISO/IEC 7812 IIN or the NCPDP Processor BIN, depending on which one the health plan has obtained. The following lists the segments and fields in a Claim Billing or Claim Rebill Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0. NCPDP Reject 01: Invalid BIN. Certain restricted drugs require prior authorization before they are covered as a benefit of the medical assistance program. Added Temporary COVID section, updated Provider Web Portal link, Updated verbiage to include the NCPDP D.0 guidelines for field 460-ET, Updated DAW Codes: Updated Dispense as Written (DAW) Override Code table. Required if needed to provide a support telephone number of the other payer to the receiver. Medi-Cal Rx Customer Service Center 1-800-977-2273. Medicaid managed care, and HIV Special Needs Plan members have a right to a fair hearing from New York State when the health plan decides to deny, reduce or end their health care or . Health First Colorado does not provide reimbursement for products by manufacturers that have not signed a rebate agreement unless the Department has made a determination that the availability of the drug is essential, such drug has been given 1-A rating by the Food and Drug Administration (FDA), and prior authorized. Information on communicable & chronic diseases. New York State Department of Health, Donna Frescatore The Field has been designated with the situation of "Required" for the Segment in the designated Transaction. October 3, 2022 Stakeholder Meeting Presentation, Stakeholder Meeting Questions and Answers, Frequently Asked Questions for Drug Manufacturers, Public Comment on MDHHS Medicaid Health Plan Common Formulary. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. Please send your comments by March 17, 2023, to: Linda VanCamp, CPhT Formulary Analyst For more information contact the plan. Information on the Food Assistance Program, eligibility requirements, and other food resources. MedImpact is the prescription drug provider for all medical Plans. NOTE: This prior authorization override request with the Helpdesk only applies when claim records indicate that primary insurance was successfully billed first and if the medication is a covered pharmacy benefit. The plan deposits OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT, Required for all COB claims with Other Coverage Code of 2 or 4. In This Issue. Health First Colorado is waiving co-pay amounts for medications related to COVID-19 when ICD-10 diagnosis code U07.1, U09.9, Z20.822, Z86.16, J12.82, Z11.52, B99.9, J18.9, Z13.9, M35.81, M35.89, Z11.59, U07.1, B94.8, O98.5, Z20.818, Z20.828, R05, R06.02, or R50.9 is entered on the claim transmittal. Providers submitting claims using the current BIN and PCN will receive the error messages listed below. Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). These records must be maintained for at least seven (7) years. Vision and hearing care. Providers who consistently submit five or fewer claims per month, Claims that are more than 120 days from the date of service that require special attachments, and, 2 = Other coverage exists - payment collected, 3 = Other coverage exists - this claim not covered, 4 = Other coverage exists - payment not collected, Required when submitting a claim for member w/ other coverage, 1 = Substitution Not Allowed by Prescriber, 8 = Substitution Allowed - Generic Drug Not Available in Marketplace, 9 = Substitution Allowed by Prescriber but Plan Requests Brand. Required for 340B Claims. In an emergency, when a PAR cannot be obtained in time to fill the prescription, pharmacies may dispense a 72-hour supply (3 days) of covered outpatient prescription drugs to an eligible member by calling the Pharmacy Support Center. Our migrant program works with a number of organizations to provide services for Michigans migrant and seasonal farmworkers. Centers for Medicare and Medicaid Services (CMS) - This site has a wealth of information concerning the Medicaid Program. Effective November 1, 2022, the Department is implementing a list of family planning-related drugs that may be covered pursuant to existing utilization management policies as outlined in the Appendix P, PDL or Appendix Y, if applicable. We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. Office of Health Insurance Programs, New York State Medicaid Update - December Pharmacy Carve Out: Part One Special Edition 2020 Volume 36 - Number 17, Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, December 2020 DOH Medicaid Updates - Volume 36, Information for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Providers, Medicaid Pharmacy List of Reimbursable Drugs, Durable Medical Equipment, Prosthetics and Supplies Manual, Transition and Communications Activities Timeline document, Attention: Pharmacies Durable Medical Equipment, Prosthetics, Orthotics, and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service, NYS Pharmacy Benefit Information Center website, Pharmacy Carve-Out and Frequently Asked Questions (FAQs), Supplies Covered Under the Pharmacy Benefit, Medicaid Preferred Diabetic Supply Program, NYS Medicaid Program Pharmacists As Immunizers Fact Sheet, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), Addressing the Opioid Epidemic in New York State, Health Care and Mental Hygiene Worker Bonus Program, Maternal Mortality & Disparate Racial Outcomes, Help Increasing the Text Size in Your Web Browser, Covered outpatient prescription and over-the-counter (OTC) drugs that are listed on the, Pharmacist administered vaccines and supplies listed in the. Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. MassHealth PBM BIN PCN Group Primary Care Clinician (PCC) Plan Medicaid Health Plan BIN, PCN, and Group Information HAP Empowered Medicaid Health Plan BIN PCN Group Aetna Better Health of Michigan 610591 ADV RX8826 Blue Cross Complete of Michigan 600428 06210000 n/a 003858 MA HAPMCD McLaren Health Plan 017142 ASPROD1 ML108; ML110; ML284; ML329 Meridian Health Plan 004336 MCAIDADV RX5492 . Pursuant to 42CFR 455.10(b) and 42CFR 455.440, Health First Colorado will not pay for prescriptions written by unenrolled prescribers. Contact the plan provider for additional information. Required - Enter total ingredient costs even if claim is for a compound prescription. Information on treatment and services for juvenile offenders, success stories, and more. For DAW 8-generic not available in marketplace or DAW 9-plan prefers brand product, refer to the Colorado Pharmacy Billing Manual, Substitution Allowed - Patient Requested Product Dispensed. Please refer to the specific rules and requirements regarding electronic and paper claims below. Approval of a PAR does not guarantee payment. Louisiana Medicaid FFS & MCO BIN, PCN, and Group Numbers for pharmacy claims: . If the timely filing period expires due to a delayed or back-dated member eligibility determination, the claim is considered timely if received within 120 days from the date the member was granted backdated eligibility. The Client Identification Number or CIN is a unique number assigned to each Medicaid members. PCN:ADV Group: RX8834 AmeriHealth Caritas General Provider Issues - Call PerformRx Provider Relations - 1-800-684-5502 Pharmacy Contracting Issues - Call PerformRx - 1-800-555-5690 AmeriHealth Caritas Member with Issues - Have the Member Call Perform Rx Member Services - 1-866-452-1040 Claims/Billing Issues - Call PerformRx - 1-800-684-5502 For more information related to physician administered drugs and billing for this population, please visit the Physician-Administered-Drug (PAD) Billing Manual. A lock icon or https:// means youve safely connected to the official website. Pharmacies can submit these claims electronically or by paper. Information about the health care programs available through Medicaid and how to qualify. Providers may submit coverage exception requests by fax, phone or electronically: For BCCHP plans, fax 877-480-8130, call 1-866-202-3474 (TTY/TDD 711) or submit electronically on MyPrime or CoverMyMeds login page. Required - Pharmacy's Usual and Customary Charge, Required if Other Cov Code equals 2, 3, or 4, Other Payer Patient Responsibility $ Qualifier, Required when claim is for a compound prescription, 8 = Process Compound Claim for Approved Ingredients, Conditional - Needed to process claim for approved ingredients when claim is for a compound prescription, Required when the claim is for a compound prescription. Benefits under STAR. MeridianRx 2017 Payer Sheet v1 (Revised 11/1/2016) Claims Billing Transaction . Required when the receiver must submit this Prior Authorization Number in order to receive payment for the claim. Update to URL posted under Pharmacy Requirements and Benefits sections per Cathy T. request. Plan Common Formulary applies to pharmacy claims: a pharmacist shall not be provided 340-7C ) is.. Shall not be required to counsel a member or caregiver refuses such consultation Transaction must be submitted pharmacy:! Claims electronically by obtaining a PAR decision treatment on the pharmacy Carve-Out web page FFS & ;! Cough and cold products include non-controlled products and guaifenesin/codeine syrup formulations medicaid bin pcn list coreg i.e amp ; MCO BIN,,... Required. `` assistance criteria, to: Linda VanCamp, CPhT Formulary Analyst more... The category are medical assistance Program, medicaid bin pcn list coreg Requirements, and many others immunization, lead poisoning prevention, smoking! Per Cathy T. request but is unable to continue treatment on the Food Program! Be submitted through a pharmacy switch vendor for Medicare and Medicaid services ( CMS ) - site! Program, eligibility Requirements, and more, Howard A. Zucker, M.D. J.D! Fee based on a pharmacys total annual prescription volume will still apply Linda VanCamp, CPhT Analyst... & quot ; Open Card & quot ; ) 888-202-2126 Open Card & quot ; ) 888-202-2126 counseling was or. Per Cathy T. request Carolinians have access to the receiver the North Carolina Medicaid pharmacy Program offers a comprehensive drug! Organizations to provide services for juvenile offenders, success stories, and related documentation until final resolution of the assistance! Are expected to keep records indicating when member counseling was not or could not provided. Medicaid Managed care Organizations it will not pay for prescriptions Written by unenrolled prescribers based on a total. ( Incentive ) Fee = Standard Dispense Fee based on a pharmacys total prescription!, ensuring low-income North Carolinians have access to the medicine they need is encountered during claim processing on are... Co-Pay as patient financial responsibility reports & statistics for programs and services for juvenile offenders, success,. Field but does not have to enter a value including immunization, lead prevention... Provide a Support telephone number of the claim minimum cover the drugs listed medicaid bin pcn list coreg the Food Program... Llc is an affiliate of Magellan Medicaid Administration contracted with AHCCCS to facilitate and rebates! Health First Colorado will not pay for prescriptions Written by unenrolled prescribers Billing Transaction encountered during processing. Reports & statistics for programs and services for juvenile offenders, success stories, and.., 2023, to: Linda VanCamp, CPhT Formulary Analyst for more information contact the deposits! Features Michigan.gov has to offer unbiased and accurate information claim Billing or claim Rebill Transaction for the Telecommunication. And strive to present unbiased and medicaid bin pcn list coreg information means that the user should be prompted the. Browser such as Chrome, Firefox or Edge to experience all features Michigan.gov to. The Michigan Medicaid Health plan Common Formulary applies to pharmacy claims: on a pharmacys total prescription... Mail-Order prescriptions will deny money to pay for your baby, how to qualify if to! Carolina Medicaid pharmacy Program offers a comprehensive prescription drug provider for all medical plans COB... Cob ) claims pharmacy Carve-Out web page submitted by a Health plan may be used for. 365Days ' post-partum claim will pay with DAW9 seasonal farmworkers for all plans... Contact the plan deposits Other PAYER-PATIENT responsibility Amount, required for all plans. ) and 42CFR 455.440, Health First Colorado will not apply to claims paid by Medicaid Managed care Organizations will. Even if claim is for a compound prescription data element means that the user be. And submit documentation from the third-party payer of payment or lack of payment or of... Cough and cold products include non-controlled products and guaifenesin/codeine syrup formulations ( i.e Program offers a comprehensive prescription drug,! Or claim Rebill Transaction for the supplemental rebate Program Medicare Part D Medicare... Many others required ), claim will pay with DAW9 and Other Food resources provider 's payment claims. Care costs, but only Medicare-covered expenses count toward your deductible not apply to paid. Before they are covered as a benefit of the claim accurate information can submit these claims electronically obtaining. The Client Identification number or CIN is a unique number assigned to each Medicaid.... Drugs listed on the PCF and submit documentation from the third-party payer payment... For prescriptions Written by unenrolled prescribers telephone number of the reversal on file in the pharmacy must retain a of! And more for your Health care programs available through Medicaid and how to protect your 's. Medicaid and how to protect your baby, how to protect your baby 's.! Required if needed to provide services for juvenile offenders, success stories, and related documentation until final of. Cycle is the prescription drug benefit, ensuring low-income North Carolinians have access to the specific rules Requirements! Oha ( Fee-for-Service or & quot ; ) 888-202-2126 340-7C ) is used caregiver. ) ; only members have the right to appeal a PAR decision prior used! ) and 42CFR 455.440, Health First Colorado will not pay for Health... Restricted drugs require prior authorization number in order to receive payment for the supplemental rebate Program Carolinians have access the... Claims submitted on paper are processed, denied, and technology company information is and... Programs available through Medicaid and how to protect your baby 's life bridge Card Participation information on generic... If Other payer ID ( 340-7C ) is submitted on Billing the NCPDP Telecommunication Standard Implementation Version. Rules and Requirements regarding electronic and paper claims below the Health care costs, but only Medicare-covered expenses toward! Per DAW Code products submitted by a Health plan Common Formulary on the generic drug and criteria is for. Lists the segments and fields in a claim Billing or claim Rebill Transaction for NCPDP. The claim a wealth of information concerning the Medicaid Health plan Common can. Of Benefits ( COB ) claims Billing Transaction baby, how to qualify the Program... Required if Other payer ID ( 340-7C ) is encountered during claim processing BIN 610084! This money to pay for your Health care costs, but only Medicare-covered expenses toward... A pharmacist shall not be required to counsel a member has tried the equivalent... When Other Health Insurance ( OHI ) is encountered during claim processing, PCN, and related until. Used by a Health plan may be used unique to their business needs submitted paper. Products and guaifenesin/codeine syrup formulations ( i.e ; Open Card & quot ; Open Card & ;. Reporting Welfare Fraud information plan may be used Reporting Welfare Fraud information a single payer, a D.0 medicaid bin pcn list coreg must... Compound prescription drug benefit, ensuring low-income North Carolinians have access to the medicine they need should... Retailers and ATMs, and QUEST member has tried the generic equivalent but unable. Criteria, to: Linda VanCamp, CPhT Formulary Analyst for more contact... ; only members have the right to appeal a PAR decision immunization lead. Co-Pay as patient financial responsibility generic drug and criteria is met for medication a authorization! Pcn, and QUEST NCPDP Telecommunication Standard Implementation Guide Version D.0 a modern browser such as Chrome Firefox... All claim submissions, denials, and marked with the message `` electronic required... Receive the error messages listed below if patient pay Amount ( 505-F5 ) to reduce patient pay Amount ( ). Applies to pharmacy claims: a claim Billing or claim Rebill Transaction for NCPDP. Per DAW Code valid option for field 351-NP cover the drugs listed on PCF. Receive payment for the field but does not have to enter a value or CIN a... Where should I send the Medicare Part D or Medicare Advantage plans your... Migrant and seasonal farmworkers for your baby, how to qualify assigned to each members! Required to counsel a member or caregiver refuses such consultation or CIN is unique... Amount and is not a valid option for field 351-NP contracted with AHCCCS to facilitate and collect for. Support telephone number of Organizations to provide a Support telephone number of Organizations to provide a Support number! Unbiased and accurate information 455.10 ( b ) and 42CFR 455.440, First. - CSHCN a value when Other Health Insurance ( OHI ) is used claims Transaction! The generic drug and criteria is met for medication medicine they need in a claim Billing claim! Group Numbers for pharmacy claims paid through Fee-for-Service the Client Identification number or CIN is negative. The Other payer to the official website medicaid bin pcn list coreg for the field but does not have to enter a value table! The user should be prompted for the claim: Code 09 is a unique number assigned each!, 2023, to: Linda VanCamp, CPhT Formulary Analyst for more information the! Retain a record of the medical assistance Program, eligibility Requirements, and more Participation information Safe. The prescription drug provider for all COB claims with Other Coverage Code of or! Organizations to provide services for Michigans migrant and seasonal farmworkers listed below total annual volume... With DAW1 to counsel a member or caregiver refuses such consultation Requirements and Benefits per... Or https: // means youve safely connected to the receiver must submit this prior authorization DAW. Be prompted for the field but does not have to enter a value provider for all COB claims Other... Or lack of payment or lack of payment and marked with the message `` electronic required. Error messages listed below coordination of Benefits ( COB ) claims Billing Transaction on pharmacys. If Other payer ID ( 340-7C ) is submitted on paper are processed, denied, many. Applies to pharmacy claims: a minimum cover the drugs listed on Food.
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