How will the Point-of-Sale (POS) Facilitated Enrollment function?
• A full dual-eligible recipient presents a prescription at the pharmacy with either a Medicaid card or a previous history of Medicaid billing in the pharmacy system patient profile. • Pharmacist bills Medicaid and the claim is denied. • Pharmacist requests photo identification and checks for Part D enrollment by submitting an E1 query to the TROOP facilitator. If the E1 query returns Part D plan enrollment information, the pharmacist bills the appropriate plan. There is no need to proceed with the Point-Of-Sale Facilitated Enrollment. • Pharmacist also checks for A/B Medicare eligibility by: – Requesting to see a Medicare card; or – Calling 1-800-MEDICARE; or – Requesting to see the Medicare Summary Notice (MSN). • If the pharmacist cannot identify the appropriate plan to bill but is able to verify both Medicaid eligibility (Step 1) and Medicare eligibility (Step 4), proceed with the Point-Of-Sale Facilitated Enrollment. • Pharmacist enters the claim into the automated pharmacy system
