December 29, 2005

Medicare Q & As
Part VI

Dual Eligible 1927 Drugs

The following link is the list of 1927 drugs (drugs that are not covered by Medicare Part D but can be billed to Arkansas Medicaid) for dual eligibles that are moving to Medicare Part D prescription coverage. 

http://www.medicaid.state.ar.us/Download/provider/pharm/1927d.xls.

E1 Transmission Accuracy 

APA has received many questions about the E1 transmission process.  Apparently, the reliability of any E1 transaction at this time is suspect – whether a patient is or is not shown to be in the system.  Although this news is not comforting, it may explain why some patients (particularly CCRx patients) are not showing up in the system.  APA has been assured that CMS is working on this problem, and the process will be more reliable soon.  As information is received, APA will keep you updated

Patients Loaded at CCRx

Many members have expressed concern (a concern that APA shares) about dual eligibles receiving cards from their auto- assigned plan but not from the plan that they actively signed up for later.  This question has most often been raised in regards to seniors who have actively signed up for CCRx.  APA has been assured that if a completed application has been sent to CCRx those seniors will be “in the system” and will have cards by January 1.  Seniors other than dual eligibles should at least have the letter that contains the pertinent information for adjudication.  APA has been informed that 92% of applications received by CCRx were complete and accurate and are in process.  The delay seems to be from the CMS end.  The other 8% are for applications that were incomplete or incorrect and are being hand corrected through direct contact with the patient.

Wellpoint/Z-Tech Information

CMS has contracted with two companies to deal with dual eligibles that may come into the pharmacy and “fallen through the crack” with no coverage.  Z-Tech Corporation will handle the eligibility piece; however, APA has been unable to find out exactly how to perform this process.  After the eligibility has been handled, claims will be billed to Wellpoint.  The billing information for Wellpoint will require BIN # 610575 and Processor Control # CMSDUAL01 as well as all pertinent patient information.  Follow the link below to get the full 14 step process with Wellpoint–

http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=6248

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