Due to the high volume of new small groups being implemented, Blue Cross and Blue Shield of Kansas City (Blue KC) group activation is taking longer than normal and production and distribution of Blue KC member ID cards are delayed.

Members who are covered under one of these groups but haven’t received their ID cards yet will need to pay for the cost of their healthcare services and/or medications. Then they can submit a claim form to request reimbursement under their Blue KC coverage.

Members can refer questions to their employer, or contact Blue KC at 800.288.1436.

If you need assistance processing a claim, please contact the Express Scripts pharmacy help desk at 800.922.1557.

Dear Valued Provider,
Effective January 1, 2017, Mississippi State and School Employees’ Health Insurance Plan preferred diabetes test strips are Ascencia products. Please see the attachment below for further processing instructions.

If you have questions regarding claims processing, please call the Prime Contact Center at 855.457.0408 .

Sincerely,
Pharmacy Network Management
Prime Therapeutics LLC
Prime Therapeutics Contracting Fax number: 877-823-6373

From September 1, 2016 through January 17, 2017, several specialty medications were processed and covered at the retail level in error. Going forward, these medications must be filled by AcariaHealth, Envolve Pharmacy Solutions’ specialty pharmacy. Envolve Pharmacy Solutions is the Pharmacy Benefit Manager (PBM) for Buckeye Health Plan.

PQS has moved details and language within the EQuIPP dashboard for all users as it relates to qualifying patient counts (i.e. denominators). The information previously in the resources section and has been moved to the bottom of the dashboard main page along with the ‘Analyze Performance’ pages.   The language below clarifies the use of performance data associated with smaller population sizes.  There is no change in any calculations or functions within EQuIPP.  We have been asked to move this by the Pharmacy Quality Alliance (PQA). Please note:  These recommendations are provided in the PQA Measure Manual, which PQS uses as standard measure evaluation for many of the quality measures hosted in EQuIPP.  

Please see the attached PDF for more information on Express Scripts Network Pharmacy Weekly for January 26, 2017.