About APCI

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Since 1984, APCI has been the ‘united voice of independent pharmacy’

APCI began as a small buying group for a limited number of independent pharmacies in central Alabama. Since that time, the cooperative has grown to more than 1,800 members pharmacies in 26 states, and provides its members with a wide range of products and services.

Our mission is to represent the economic and professional interests of independent pharmacies by providing leadership, vision, and a collective voice for our members in the healthcare marketplace. Our goal is to level the playing field for our member pharmacies by providing innovative, targeted programs to benefit our entire membership.

17

Oct

2016

OptumRx: Submission Clarification Code (SCC) Proper Usage

You are receiving this notice as a reminder of the proper usage for Submission Clarification Code (SCC) 42.

SCC 42 use should be reserved for providing clarification on the reason the pharmacy is overriding a claim rejection. This should be done based on evidence obtained for validating the Prescriber ID submitted as active and valid on the Date of Service. Routine use of SCC 42 without a rejection is considered non-compliant with established protocol.

PLEASE NOTE: It is inappropriate to use SCC codes without appropriate evaluation of the situation on a rejected claim. Selection of the SCC must be in accordance with the situation for which an override is being placed. SCC 42 should never be included on an initial claim transition.

ACTION REQUIRED: Please immediately alert the staff to only submit SCC where appropriate for a rejection and only based upon accurate information reflecting the reason for the selected SCC code.

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17

Oct

2016

Prime Therapeutics: Pharmacy Remittance Adjustments

October 14, 2016

Dear Valued Provider,

Prime experienced a system issue that caused retail Medicare Part D claims for Alabama Covered Persons to adjudicate at an incorrect rate. Prime will be internally adjusting these claims to ensure the proper reimbursement is passed along to your pharmacies.
 
These impacted claims should appear on your remittance for the week of October 24, 2016. 
If you have questions about this notice, call Prime at 888.277.5510, option 2. You can also email your question to pharmacyops@primetherapeutics.com.  


Sincerely,
Pharmacy Network Management
Prime Therapeutics LLC
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14

Oct

2016

Navitus: Network Bulletin - New Plan Announcement — State of Texas Medicaid STAR Kids Program

Effective November 1st 2016

Effective November 1, 2016, Navitus Health Solutions will provide pharmacy benefits claim processing for State of Texas Medicaid STAR Kids plan members of Children’s Medical Center Health Plan. Children’s Medical Center Health Plan will use Navitus Health Solutions’ Texas Health Plans pharmacy network. The service area for this client is Dallas County. This client allows 30-day supplies of medications for its members.


*Please see attached PDF for more information.

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14

Oct

2016

Express Scripts: Network Pharmacy Weekly

Inside this issue of Express Scripts Network Pharmacy Weekly, you will find the following:

  • External Code List (ECL) Update-Final Reminder
  • Medicare D Compliance Attestation
  • Medicare D Pharmacy Notice Reminder
  • Amerigroup Formulary Correction

*Please see attached PDF for more information.

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14

Oct

2016

OptumRx: Flu Season Communication 2016-2017

Dear Person Responsible for Third Party Contracting:

OptumRx appreciates your pharmacy’s current participation in the Commercial and Medicaid pharmacy networks administered by OptumRx. In accordance with the Vaccine and Immunization Injection2 Network Compensation Exhibit to the Pharmacy Network Agreement, OptumRx is providing the Flu Season Communication for 2016-2017. This communication highlights established vaccines currently on the program with the total reimbursement per dose and introduces new vaccines available for distribution. Please note the new vaccine for 2016- 2017 is not effective under an All-Inclusive Rate until October 1, 2016 and coverage is dependent on member eligibility and status.

If you have any questions, please contact your assigned Network Contract Associate or Manager for additional details.

Sincerely,

Pharmacy Network Contracting Department

OptumRx

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