Effective Date: 11/01/2016

Cook County Health and Hospitals Systems

Attention Pharmacy Staff: CountyCare, an Illinois Medicaid plan serving Cook County, will be making changes to the formulary effective 11/01/2016. The below communication is being sent to members in September to alert them of the change of the types of glucose monitors and test strips that will be available in their formulary. A code will be provided to the pharmacy staff in the reject message to override and allow a member a one-time fill of their current test strips during the month of November.

*Please see attached PDF for more information.

Effective 10/01/2016, new claims processing functionality will make it quicker and easier for you to resolve Therapeutic Dose Limit (THERDOSE) soft reject edits when dispensing medication for UnitedHealthcare Community Plan in Mississippi members.

THERDOSE screening monitors single ingredient and combination acetaminophen products across multiple claims to determine cumulative daily use. If claims indicate that acetaminophen usage exceeds the U.S. Food and Drug Administration (FDA)-approved maximum daily dose of 4 gm/day, the THERDOSE edit produces a soft reject: Drug Utilization Review (DUR) Reject 88.

*Please see attached PDF for more information.

Effective 10/01/2016, new claims processing functionality will make it quicker and easier for you to resolve Therapeutic Dose Limit (THERDOSE) soft reject edits when dispensing medication for UnitedHealthcare Community Plan in Louisiana members.

THERDOSE screening monitors single ingredient and combination acetaminophen products across multiple claims to determine cumulative daily use. If claims indicate that acetaminophen usage exceeds the U.S. Food and Drug Administration (FDA)-approved maximum daily dose of 4 gm/day, the THERDOSE edit produces a soft reject: Drug Utilization Review (DUR) Reject 88.

*Please see attached PDF for more information.

Effective October 1, 2016, CVS Caremark® will begin to administer the prescription benefits for HCCCC-Teamsters Local 922. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS Caremark.

*Please see attached PDF for more information.

Dear Pharmacy Network Provider,

On Tuesday, October 11, 2016, Argus will implement two global claims processing edits for point of sale (POS) and batch claims.

• Claims will then reject in the following scenarios:

o If a claim is submitted using lowercase letters in any alphanumeric field, that claim will return the NCPDP Reject Code 614 (UPPER CASE REQUIRED).

o If a claim is submitted with a decimal in the Diagnosis Code field(s), that claim will return NCPDP Reject Code 39 (MISSING/INVALID DIAGNOSIS CODE).

o Both edits are non-overridable and will not have an associated Argus Error Code.

• Pharmacies must correct the claim and resubmit for processing.