Effective January 1, 2016, Prime Therapeutics (Prime) began processing Medicare Part D and Part B claims for Covered Persons of Blue Cross Blue Shield of Illinois (BCBSIL) Blue Cross Medicare Advantage (PPO). Processing Requirements To ensure uninterrupted service to Participating Pharmacies and Covered Persons, please use the following information to set up your system prior to January 1, 2016.

CVS/caremark administers the prescription benefits for Wellmark State of Iowa, including electronic coordination of benefits. Please update or create plan member profiles to reflect the changes regarding the following plan adjudication through CVS/caremark Please update or create patient profiles to reflect the following information:

Starting January 1, 2016, Fidelis SecureCare implemented a new compounds management program for its Medicare Part D members. A number of agents will not be covered, causing compound claims to reject with NCPDP Reject 70 (Product/Service Not Covered), along with the Reject Field Occurrence Indicator (in NCPDP Field 546-4F) denoting the non-covered ingredient.

According to Minnesota Department of Human Services (DHS), there are Medicaid eligible individuals whose January health plan enrollment was cancelled or not processed. These members have been enrolled in Fee For Service Medicaid for the month of January. Therefore, if the member believes that they are eligible for State programs and the health plan claim is rejecting, please try submitting the claim to DHS under Fee for Service.

Greetings,   Please distribute the attached Quarterly Notification to all of your affiliated pharmacies located in the state of Texas.   If you have any questions, please do not hesitate to contact us.   Thank you.