How is the Pharmacy Benefit Code, ME019, to be coded in view of some of the Prescription Coverage Mandates in the State of ME?
If you cover an Employer group in the State and they opt out of any Pharmacy coverage rider, but you still have to provide benefits for items like Diabetic Supplies or certain Injectable Products, then, even though this data would come to us in the Pharmacy file transmission you would load a “”NO”” value for the member(s) in this employer group. What if our system uses “Home Grown” claim processing/CPT codes to pay certain types of claims? What do you want us to do if these codes are longer than the 5 digits that are defined in the file layout? Following HIPAA standards, eventually all “Home Grown” processing codes should be eliminated from your systems. Until that point in time we suggest that you do the following: Since the file format that you will be sending to us is a delimited ASCII file you can send us the full length value of this field in the correct data element. As part of our validation check we will verify the longest length value in this element and make sure that the Dat
Related Questions
- How is the Pharmacy Benefit Code, ME019, to be coded in view of some of the Prescription Coverage Mandates in the state of Maine?
- How is the Pharmacy Benefit Code, ME019, to be coded in view of some of the Prescription Coverage Mandates in the State of ME?
- Can I still fill a 90 day prescription at the Wright State University pharmacy?
