MedImpact Healthcare Systems, Inc. processes pharmacy claims for Medica Health Plans MINNESOTA Medicaid membership. Effective 1/1/2016, ~175,000 new members will transition to Medica from other Minnesota Health Plans. Consequently, the following information will be beneficial in processing claims for this membership.

The governors of Alabama, Illinois, Georgia, Missouri, New Mexico and Texas have declared States of Emergency due to Storm Goliath. Due to this issuance, Express Scripts has implemented Emergency Refill Too Soon procedures in the states of Alabama, Illinois, Georgia, Missouri, New Mexico and Texas for Part D and Medicare Advantage plans. Effective immediately, if a patient from the disaster area attempts to fill a prescription for lost or damaged medication resulting from the disaster, and the claim rejects with NCPDP Reject 79 "Refill Too Soon," the pharmacy should enter override code 91100000001 in NCPDP vD.0 field 462-EV "Prior Auth Number Submitted."

What You Need to Know Health Partners Medicare has four benefit designs for members to choose from. The plan designs are as follows: Basic, Prime, Prime Plus and Special. Health Partners has a closed, four-tier formulary for its Health Partners Medicare Prime and Health Partners Prime Plus recipients; and a closed one-tier formulary for its Health Partners Medicare Special recipients. The Pharmacy benefit plan design and benefit package is new for 2016 and is described below.

What You Need to Know   Attention Argus WEST VIRGINIA Network Pharmacies:   The MCO (Managed Care Organizations for Medicaid) requires that you have the option to be notified in advance of changes to the generic pricing utilized for West Virginia Family Health beneficiaries.  Later this fall, we will be implementing enhancements to our Argus Pharmacy Portal which will allow you to subscribe to an alert system which will notify you when changes to the MAC pricing are being made.  When that enhancement is completed, we will send another bulletin with instructions on how to register for those alerts.   In the interim, we will be emailing the MAC changes to you at this email address.  If you wish to OPT OUT, please reply to the email notification and add “OPT OUT” to the subject line before sending.  We will gladly remove you from our distribution list. Action Required If you have any questions, please feel free to reach out to our MAC team via email to macinquiries@argushealth.com

Sent in conjunction with MIPA     Medicaid Provider Notice MS Division of Medicaid has activated pharmacy billing procedures in times of officially declared emergencies During states of officially declared emergencies, DOM has a new pharmacy point of sale (POS) procedure. As of the time of this email, this has been activated. At the time of this email, Benton, Marshall, Panola, Prentiss, Quitman, and Tippah counties have been declared as official emergency counties. Pharmacists should enter a value of ’13-Payor Recognized Emergency’ in NCPDP Field ‘420-DK’ when it is necessary to override the following service limit edits: • 2 Brand/5 Prescription Limit • Early Refill Please note that when the declared emergency announcement is made, the fields noted above will be opened for the specified time period. Pharmacy providers are advised to use professional judgment in emergency situations. The Division of Medicaid may conduct audits after such events to ensure appropriate care was taken in dispensing medications for affected beneficiaries. Providers and beneficiaries residing and/or receiving care not in an evacuation and/or disaster area must have documentation on file to justify rationale for early/excess fills. Medicaid monies may be recouped if supporting documentation is not found.