schumann@dphss. INDEPENDENT HEALTH D. 2 Emergency PA Protocol 7 5. Plan Name/Group Name: AmWINS – QHP. 1Ø1 -a1 bin number (see above) m 1Ø2 -a2 version/release numb er dØ m 1Ø3 -a3 transaction code b1, b3 m 1Ø4 -a4 processor control nu mber m 1Ø9 -a9 transaction count 1 m 2Ø2 -b2 service provider id qualifier 01 m npi only 2Ø1 -b1 service provider id 10 dig it npi number m 1Ø1-A1 BIN NUMBER M ØØ97Ø4 NYS EPIC, Ø12345 Medicare D Secondary Claims 1Ø2-A2 VERSION/RELEASE NUMBER M 51 1Ø3-A3 TRANSACTION CODE M B1, B2, B3 1Ø4-A4 PROCESSOR CONTROL NUMBER M P014009704 NYS EPIC, P024012345 Medicare D Secondary Claims 1Ø9-A9 TRANSACTION COUNT M B1 = 1-4 B2 = 1-4 B3 = 1-4 NCPDP VERSION D CLAIM BILLING/CLAIM REBILL R EQUEST C LAIM B ILLING /C LAIM R EBILL P AYER S HEET ** Start of Request Claim Billing/Claim Rebill (B1/B3) Payer Sheet ** GENERAL INFORMATION . 361. 2. Updated Patient Zip Code Comments. BIN. Required fields needed for Sales Tax on Mail and Specialty. guam. As such, we Chart of 2017 BIN and PCN values for each Medicare Part D prescription drug plan (part 1 of 3) Category: Your Formulary (Drug List) Published on 2017-01-24 12:31:56 Plan Name BIN PCN Arkansas Blue Cross Blue Shield Medi-Pak Rx (PDP) Ø16895 PDPAR for Prime Therapeutics’ Medicare Part D Clients Page 2 of 14 Medicare BINs, PCNs, and RxGroups. TTY (toll-free): 1-877-908-6024 Hours: 24 hours a day, 7 days a week. Please contact Costco Health Solutions Customer Care toll-free at the number listed on your pharmacy benefit member ID card. Effective as of: 1/1/2017. PBM BINs Help Desk 4D Management Systems, Inc. v39 2 800. 1 Drugs requiring PA 7 5. com Plan Name/Group Name: Envision Medical Solutions (EMS) BIN: ØØ9893 PCN: DCAE1 Plan Name/Group Name: Medicare Card System (MCS) 1Ø1-A1 BIN NUMBER 018117 M Medicare Part D Bin 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M 1Ø4-A4 PROCESSOR CONTROL NUMBER MRXMED M Valid PCN required 1Ø9-A9 TRANSACTION COUNT 1 M Only 1 transaction for transmission for Medicare Part D claims. Plan Name/Group Name: AmWINSRx. When processing claims, please be sure to use the Rx group ID found on the members’ cards. POS Specifications 6 4. Nov 30, 2016 · bin: 005947; pcn: claimcr Health Alliance Medical Plans has received reports that members are being turned away from pharmacies and notified that Health Alliance Medical Plans is closing effective 12/31/16. state. Claims should be transmitted using Bin Number 012833. BIN: Ш13492. 06/04/2018 Page 3 of 24 HIGHLIGHTS – Updates, Changes & Reminders This payer sheet refers to Primary Commercial Primary Billing and Medicare as Secondary Kaiser (MED D) BIN:011255 PCN: COCMS COCMSN COCMSS 011222 GACMS 011214 HICMS 011859 MACMS MACMSA 011842 NCCMS 011230 NWCMS 011172 SCCMS Health Choice Management BIN 610011 PCN: HEAMEDD Health Choice Management Utah BIN 610011 PCN: HEAUMEDD Healthmarkets (HMIC) BIN: Ø1639Ø PCN: Ø128 Catamaran / Seniorscript Services BIN: Ø1317Ø PCN: Not BIN 017431 PCN EBMS Plan Name/Group Name FlexScripts BIN 017472 PCN FLEXRX Plan Name/Group Name MRx Commercial-Union BIN 017449 PCN UNION Payer Name: Magellan Rx Management Date: July 1, 2017 Plan Name/Group Name MRx Commercial – Cash Card BIN 018679 PCN 6775000 GRP 040116 Plan Name/Group Name Yale University BIN 017449 PCN YALE GRP EnvisionRxOptions Payer Sheet D. Processor: ENVISION/RX OPTIONS. DO NOT REPORT PCN VALUES OF PAAD, ADDP OR SUPPNJ ON CLAIMS WHEN THE STATE IS THE PRIMARY PAYER. 3 Filing Client PA Appeals 7 6. Required fields needed for Sales Tax on Mail and Specialty Added Bin 020123 and Helpdesk number Added PCN IRXCOMM Updated Patient Zip Code Comments Added field 46Ø-ET Quantity Prescribed (Effective/Accepted 09/21/2020) Added PCN o RSADV o DCADV The Costco Drug Directory contains pricing details for prescription drugs, plus general information for a wide range of medications. Help Desk Number. Our goal is to make it as easy as possible for you by working with your health plan and pharmacy to provide timely and essential information about your medicine, including how to take it correctly, potential side effects, any lower-cost drug options, and more. Processor Information TO REDUCE PROCESSING ERRORS, PLEASE CONFIRM THE INFORMATION ON MEMBER’S Process Control Number (PCN) for BlueScript, Mediscript and BlueCare Rx members is FLBC and the member ID number is the letter H followed by 8 or 10 numeric digits. 1 Required Data Elements 6 4. Required fields needed for Sales Tax on Mail and Specialty Added Bin 020123 and Helpdesk number Added PCN IRXCOMAP Updated Patient Zip Code Comments Added field 46Ø-ET Quantity Prescribed (Effective/Accepted 09/21/2020) Pharmacy Search With over 60,000 participating retail pharmacies in our network, it is easy to locate one near you. Sales General Sales Inquires: 1-425-416-4115 SShults NCPDP VERSION D CLAIM BILLING/CLAIM REBILL REQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request Claim Billing/Claim Rebill (B1/B3) Payer Sheet ** GENERAL INFORMATION Payer Name: NextGen Healthcare (HSI) Date: 11/05/2015 Plan Name/Group Name: NextGen Healthcare (HSI) BIN:600428 PCN: 07400000 Plan Name/Group Name: BIN: PCN: Request For ID. 0 Payer Sheet CLAIM, REVERSAL, AND RESPONSE . Member Feedback. GENERAL INFORMATION . Effective as of: December 19, 2011 : NCPDP Telecommunication Standard Version/Release #: D. For assistance, please contact the Help Desk at 877-525-5125. PCN: MEDD. 3 Adjudication Codes 6 5. Pharmacy Provider Manual 2 | P a g e About Us In an environment where plan sponsors are increasingly looking for greater transparency and accountability, Navitus Health Solutions, LLC (a division of SSM Health) stands alone as the industry alternative to traditional models with a strong commitment to lowering prescription costs. The Pharmacy Help Desk numbers are provided below: Aetna System. 4542 | envisionrx. Commercial and Medicaid BIN: 610494 PCN: 9999 COMMUNITY HEALTH BIN 610613 PCN: 2417 Maryland Medicaid BIN: 610084 PCN RXSOLPRD ProAct BIN 017366 PCN: 9999 FlexScripts/ProAct BIN 018141 PCN: 9999 MedalistRx BIN 016580 PCN: <N/A> Legacy Innoviant Commercial BIN: 610127 PCN: 02330000, 01960000, , COSF, GASF, MASF, payer sheet illustrate the updated processing rules. (24 hours a day). ga. Processor requires valid Prescriber ID#, PCN, Patient Name, and DOB for claim adjudication. Payer Name: Independent Health Jun 19, 2014 · Magellan Medicaid Administration Pennsylvania PACE and Ancillary Programs D. Medicare BINs, PCNs, and RxGroups. 0 M 1Ø3-A3 Transaction Code B1=Billing M 1Ø4-A4 Processor Control Number As indicated above M 1Ø9-A9 Transaction Count 1=One Occurrence 2=Two Occurrences 3=Three Occurrences 4=Four Occurrences M (BIN 61ØØ56 only allows TRANS COUNT = 1). You must use BIN number 610084 for all the above programs including Medicaid HealthChoice MCOs. Plan Name/Group Name BIN PCN Legacy ESI Commercial ØØ3858 A4 (or as assigned by ESI) SC (When secondary to Medicare Part D only) Legacy Medco Commercial 61ØØ14 Provided on card or anything but zeros Legacy Medco Commercial – Copay only 61ØØ14 COPAY Legacy Medco Commercial – Secondary Payer Non -Medicare Part D (Based on MUST REPORT a PCN value equal to 10 SPACES. gov BIN: 004583 . Injury only, BIN 61Ø455, PCN BCRI 3Ø6-C6 PATIENT RELATIONSHIP CODE RW Payer Requirement: Required for BCBS of OK Comp Card only, BIN Ø11552, PCN 1217 Patient Segment Questions Check Claim Billing/Claim Rebill If Situational, Payer Situation This Segment is always sent X Patient Segment Segment Identification (111-AM) = “Ø1” • BIN Number – 610084 1. 0. 0 . 009265, 610198, 012965 800-837-0581 Applied Underwriters, Inc 13329 877-234-4420 Bin List /BIN: Specify a Bin : Allows you to specify an individual bin number instead of a bin group. 5 Processing Control Number (PCN) 5 4. Prior Authorization 7 5. /INS: Specify a Name : Allows you to specify an insurance name instead of a bin group. BIN: Ш14848. Dec 09, 2011 · 3. 3. To shop for over-the-counter medications, visit Health & Beauty. Added PCN IRXCOMM. Find your plan's BINs, PCNs, and RxGroups! If there is a Part D BIN/PCN/Group missing that BIN/PCN Table . All new claims and reversals will go through this BIN number, including reversals of claims previously submitted to FirstHealth Services Corporation. This card must be accompanied by a prescription and can only be used by one patient Card may be used for up to: 24 refills of BASAGLAR (insulin glargine injection), with each fill defined as a 30 day supply 101-A1 BIN Number 014658, 610114 M 102-A2 Version / Release Number NCPDP Version D. com. Select a network pharmacy to fill your workers’ compensation prescriptions, to ensure a fast, easy and hassle free experience. 2Ø2-B2 SERVICE PROVIDER ID QUALIFIER Ø1 – NPI M Jan 15, 2016 · The BIN (600471) and PCN (7777) numbers have not changed. us Georgia Dept Health GAMD01AP BIN/PCN combination BIN: 004519 PCN: GA01AP will still be in effect for non-Part D claims. Ａ５♪2020年1月始まり・週間・ホリゾンタルレフトタイプスケジュールとメモをしっかり書く 人にピッタリです！ 。2020年版 コクヨ キャンパスダイアリーウィークリーＡ５ ニ-CWHS- A5-20（ニCWHSA520） 薄茶 ホリゾンタルレフト・ウィークリータイプ CampusDiary Ｂ６♪2020年1月始まり・週間・ホリゾンタルレフトタイプスケジュールとメモをしっかり書く 人にピッタリです！ 。2020年版 コクヨ キャンパスダイアリーウィークリーＢ６ ニ-CWHS- B6-20（ニCWHSB620） 薄茶 ホリゾンタルレフト・ウィークリータイプ CampusDiary Which BIN number do I enter to adjudicate the claim? Please login to the pharmacy portal and refer to the Payer Sheets. 0 M 103-A3 Transaction Code B1 - Billing M 104-A4 Processor Control Number IPM, IPMCOB, PV, SSD M 109-A9 Transaction Count 1 - 4 M 202-B2 Service Provider ID Qualifier 01- NPI – National Provider ID 07- NCPDP ID M PBM HELP DESK# BIN# PC# 4 D Management aClaim 888-422-5246 005848 nla ACS 800-365-4944 610084 DRSMPROD AETNA 800-238-6279 001684-Aetna HMO 00670000 610502-Non HMO Alagap 610489 ALGA Ameriscript 800-767-4226 012924 Varies by card plan 610640 Anthem 800-662-0210 610575 00890000 APS 877-277-7934 610704 APSRX BIN # 004915 PCN FIELD - WRI No Deductible / No Co-Pay Questions: 800-388-3406 SEICTF State of Alabama State Employee Injury Compensation Trust Fund SEICTF Present To Pharmacy RX Billing Instructions: File charges through BCBS-AL Use WRI prefix with the Social Security Number Group # 32035 – DO NOT USE THE EIB NUMBER オンライン通販のAmazon公式サイトなら、コクヨ キャンパスダイアリー 手帳 2020年 A5 ウィークリー 薄茶 ニ-CWHS-A5-20 2020年 1月始まりを文房具・オフィス用品ストア で、いつでもお安く。当日お急ぎ便対象商品は、 当日お届け可能です。アマゾン配送 28 May 2020 payer sheet illustrate the updated processing rules. NCPDP VERSION D CLAIM BILLING/CLAIM REBILL REQUEST CLAIM BILLING/CLAIM REBILL PAYER SHEET ** Start of Request Claim Billing/Claim Rebill (B1/B3) Payer Sheet ** GENERAL INFORMATION Payer Name: Alliant Health Plan Date: 12/04/2017 Plan Name/Group Name: Alliant Health Plan BIN:019439 PCN:07720000 Processor: DST Pharmacy Solutions, Inc. Added Bin 020123 and Helpdesk number. 2 Claim Reversals 6 4. Does Navitus provide a website for pharmacies? Yes, pharmacies may login to Navi-Gate for Pharmacies here or using . BIN: Ш15185. PCN: N/A. Aetna. BIN 610515 claims requiring a PCN containing 10 spaces submitted on or after March 1, 2010 will be denied with NCPDP REJECT CODE 04 (M/I Processor Control Number) when the PCN is not 10 spaces. 4 Jun 2018 Primary BIN and PCN Values 22 Pharmacy Help Desk. 4 Bank Identification Number (BIN) 5 3. Payer Name: AmeriHealth Caritas Delaware Date: 10/30/2017 Plan Name/Group Name: AmeriHealth Caritas Delaware BIN:600428 PCN:07710000 Plan Name/Group Name: BIN: 1Ø1-A1 BIN Number See BIN/PCN table, above M 1Ø2-A2 Version Release Number DØ=Version D. NCPDP Data Dictionary Version Date: July 2007 : NCPDP External Code List Version Date: October 2009 Transmit claim online to RxBlN 018844. /BINA: AmWINS : 011289, 013492, 013527, 014848, 015178, 015185, 016341 /BINB: Argus payer sheet illustrate the updated processing rules. NCPDP. GU GUAM ADAP Guam ADAP Bernie Schumann bernadette. 600428 800-522-7487 Agelity, Inc. コクヨ キャンパスダイアリー 手帳 2020年 B6 ウィークリー 薄茶 ニ-CWHS-B6-20 2020 年 1月始まりならYahoo!ショッピング！802円～ご購入可能です。最安値情報や製品 レビューと口コミ、評判をご確認頂けます。 2020年|コクヨ|手帳CampusダイアリーホリゾンタルレフトタイプA5|ニ-CWHS-A5-20 薄茶:4901480348377:2020年 コクヨ 手帳 Campusダイアリーホリゾンタルレフト タイプA5 ニ-CWHS-A5-20薄茶 - 通販 - Yahoo!ショッピング. 0 Payer Specification Proprietary & Confidential Page 3 of 68 Revision Date: June 20, 2014June 19, 2014 Transaction Header Segment Claim Billing/Claim Re-bill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø9-A9 TRANSACTION COUNT 1 One Occurrence Moved from a non-unique PCN to unique PCN effective 04/01/2013. verified by ADAP Consortium GA GA ADAP 610568 ADAP Libby Brown lsbrown@dhr. PCN: Blank fill : Processor: Blue Cross & Blue Shield of Mississippi . To provide any member feedback, please contact CHSMemberFeedback@costco. PCN : CMSPARTD. MedImpact is a pharmacy benefit manager who works with your health plan to get you the medication you need. bin 020974 pcn cwhs