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3001 E. Pershing Blvd. BIN 610591 20107 610649 4336 4336 610494 11529 PCN ADV KY 3191501 MCAIDADV MCAIDADV 4040 P022011529 GROUP RX8831 WKVA RX5035 RX8893 ACUKY KY Medicaid PBM CVS Caremark IngenioRx Humana Pharmacy Solutions CVS Caremark CVS Caremark Optum Rx Magellan Kentucky Medicaid Bin/PCN/Group Numbers Effective 1/1/2021. Program Member ID Required BIN PCN Group Processor/Helpdesk # Amerigroup Member or Medicaid ID 003858 MA WKJA Express Scripts/ 1-844-367-6112 CareSource Member or Medicaid ID 004336 MCAIDADV RX0835 CVS Caremark/ 1-844-441-8024 Peach State Medicaid ID 004336 MCAIDADV RX5439 Evolve Pharmacy/Caremark/1-844-297-0513 › Get more: Medicaid bin pcn group Show List Health . You must use BIN number 610084 for all the above programs including Medicaid HealthChoice MCOs. 1 0 obj $���Q��-�b%����*X�k�%���Hˠc���g��C1٠$��8�)i2�����,�y��YE9���v:.B�@�N7Waz�z�����̢�L��Q��)����@ The Primary Care Network (PCN) program closed on March 31, 2019. Commercial and Medicaid BIN: 610494 PCN: 9999 Community Health BIN: 610613 PCN: 2417 ProAct BIN: 017366 PCN: 9999 FlexScripts/ProAct BIN: 018141 PCN: 9999 United Healthcare Community Plan of Texas BIN: 610494 PCN: 4400 United Healthcare Community Plan of Arizona BIN: 610494 PCN: 4100 MedalistRx BIN: 016580 PCN: Scripts. Please note, the data below is Part 1 of 5 (E0654 - H2334) with links to Parts 2 through 5. %PDF-1.5 %���� Medicaid Information 1-800-662-9651 or (801) 538-6155 Provider Enrollment (801) 538-9050 Medicare D 1-800-633-4227 or (801) 313 4600 Option 5 PCN Hotline 1-888-222-2542 or … Fax: 855-329-5205. The Transaction Header Segment is mandatory. For questions regarding claims, call 800-222-3986. Community Health Group | Provider portal helps make your . Express Scripts: 1-844-367-6112. Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing For eligibility information, plan policy and coverage questions For billing issues, claim processing questions and assistance with claim edits Affinity Health Plan (866) 247-5678 CVS Caremark (800) 364-6331 ADV 004336 Group: RX4212 Amerigroup (800) 454-3730 CVS Caremark (800) 364-6331 ADV 004336 … CMO Pharmacy Contact Information. Bin Number: 004740 . CVS Caremark CVS Caremark CVS Caremark. Plan Name/Group Name: Hawaii Medicaid (test) BIN: 61ØØ84 PCN: DRHIACCPDØ = D.Ø Testing PCN: DRHIACCP all testing after 1/1/2012 Processor: ACS, A Xerox Company Effective as of: January 1, 2012 NCPDP Telecommunication Standard Version/Release #: D.Ø NCPDP Data Dictionary Version Date: Current NCPDP External Code List Version Date: June, 2010 Contact/Information Source: Other … See Appendix A and B for BIN/PCN. 280 0 obj <>stream [�� �m��g��-00vt400�w���C[C=F��hòVV�8#e��K������_��0j7�a��^¯ ���P��ܯ���00� Please note, the data below is Part 1 of 5 (E0654 - H2235) with links to Parts 2 through 5. Author: jessica.jump Created Date: … ADMINISTRATIVE & LEGAL CONTACTS : Mailing Address: PO Box 5624 Montgomery, AL 36103-5624: Street / Shipping Address: 501 Dexter Avenue Montgomery, AL 36104 Click here for directions to Medicaid's Central … endstream endobj 242 0 obj <. Medicaid Contacts. ŒT /"������C�o�5�H��7��{ �抽ٲ�16�B��_�{âc�dǡ�L"�)�L3�vw�o>��^�~[l��={_TF. Medicare/Medicaid Members BIN: 004336 PCN: MEDDADV Group: RX5060 1-866-693‐4620 Medicaid Only Members BIN: 004336 PCN: MCAIDOH Group: RX0867 1-800-364‐6331 CVS/Caremark Specialty Pharmacy 1-800-237‐2767 https://www.molinahealthcare.com/members/oh/en-US/hp/mycare/duals/coverd/Pages/presdrugs.aspx United Healthcare Community Plan OptumRx 1-877-889‐6510 Medicare/Medicaid Members BIN: 610097 PCN: … The Centers for Medicare & Medicaid Services (CMS) will process all claims for payment for COVID-19 vaccine (COVAX) administration for the vast majority of Medicare beneficiaries. Kentucky DMS 340B Procedures. x��][o��~��0@��Z$��[�X v��M�&F���AkѶ���Ht��I��=�o�\(Q�����3�9s�3�����\�.nJ����e���/����z�������b~��[m�j��z��į�R,���śK����(��_��X?�\�]��ٿ~`���.��?��̙ Louisiana Medicaid Single Preferred Drug List (PDL) Louisiana Medicaid Single PDL – Fee for Service and Managed Care Organizations (Effective 1/1/2021) Louisiana Medicaid Single PDL – Letters of Support Magellan Medicaid Administration South Carolina D.0 Payer Specification Proprietary & Confidential Page 7 of 66 Revision Date: November 10, 2011 Claim Segment Segment Identification (111-AM) = “Ø7” Claim Billing/Claim Re-bill Field # NCPDP Field Name Value Payer Usage Payer Situation 7 = Substitution Not Allowed- For numbers not listed here, call Medicaid's main switchboard at (334) 242-5000 for assistance. The table also lists values as defined under Version D.Ø. endobj If you do not know one of these values, you will need to contact NY Medicaid to obtain them. ��b��9�=�`mz���`6��?�F�8����?�Ẇ�l�go���`�鴝? 2 0 obj }�׻��0�Q�'����=��yLH3��>��ys�` ^B%I %���� Both of these values are provided by NY Medicaid. M – Mandatory as defined by NCPDP R – Required as defined by the Processor Added PCN IRXCOMM Added field 46Ø-ET Quantity Prescribed (Effective/Accepted 09/21/2020) Moved BIN 610502 to Payer Sheet (no changes were made to current setups) PCN: PIN + 3 or 4 character ETIN. Health Details: If you do not have log in access, and need to submit a provider dispute, please contact the Community Services Department at 1-619-240-8933. BIN/PCNs reported by SPAP/ADAPs as supplemental to Part D see: NCPDP SPAP/ADAP BIN/PCN List; BIN/PCNs for Plans supplemental to Part D reported by either the plan or a processor; BIN/PCNs contained in Other Health Insurance (OHI) records on the CMS Eligibility File where: A BIN/PCN combination where the PCN is not blank has more than 10 beneficiaries; BIN is registered with the … Kentucky Medicaid Bin/PCN/Group Numbers effective Jan. 1, 2021. Plan Name/Group Name: Arkansas Medicaid BIN: 017606 PCN: P027017606 Processor: Magellan Medicaid Administration Effective as of: 03/14/2015 NCPDP Telecommunication Standard Version/Release #: D.0 NCPDP Data Dictionary Version Date: October, 2013 NCPDP External Code List Version Date: October, 2013 Contact/Information Source: For questions prior to 03/14/2015, please … For KHC drug claims, the BIN is 610084, the PCN is DRTXPRODKH and the Group is KHC. Keep your KHC Client ID ready when calling. endobj 265 0 obj <>/Filter/FlateDecode/ID[<0C91C8232D384248A9F1CDE466D706C4>]/Index[241 40]/Info 240 0 R/Length 111/Prev 645913/Root 242 0 R/Size 281/Type/XRef/W[1 3 1]>>stream Pharmacy provider relations support for legacy Medicaid will continue to be handled by the Medicaid fiscal intermediary, DXC Technology. Medicaid Unique BIN_PCN RX BIN Number RX PCN RX Group Line of Business NCPDP Version Effective as of 017142 ASPROD1 ML108 Medicaid D.0 January 1, 2019 017142 ASPROD1 ML109 Medicaid D.0 January 1, 2019 017142 ASPROD1 ML110 Medicaid D.0 January 1, 2019 017142 ASPROD1 ML284 Medicaid D.0 January 1, 2019 017142 ASPROD1 ML329 Medicaid D.0 January 1, 2019 . Plan Name/Group Name: Ohio Medicaid BIN: Ø15863 PCN: OHPOP Processor: Goold Health Systems (GHS) Effective as of: June 12, 2Ø16 NCPDP Telecommunication Standard Version/Release #: D.Ø NCPDP Data Dictionary Version Date: July 2ØØ7 NCPDP External Code List Version Date: July 2013 Contact/Information Source: Certification Testing Window: Certification … <> … 340B Manual Comments and Responses. MedImpact … On Hold-340B Policy and Procedures Manual. Current National Council for Prescription Drug Programs (NCPDP) standard version. Payer Name: Idaho Medicaid Date: Date of Publication of this Template Plan Name/Group Name: ID01/IDMEDICAID BIN: 014864 PCN: P043014864 Processor: Magellan Rx Management Effective as of: 01/01/2012 NCPDP Telecommunication Standard Version/Release #: D.0 NCPDP Data Dictionary Version Date: June, 2010 NCPDP External Code List Version Date: June, 2010 Contact/Information … Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing For eligibility information, plan policy and coverage questions For billing issues, claim processing questions and assistance with claim edits Affinity Health Plan (866) 247-5678 CVS Caremark (800) 364-6331 ADV 004336 Group: RX4212 Amerigroup (800) 454-3730 CVS Caremark (800) 364-6331 ADV 004336 … 2. 7500 Security Boulevard, Baltimore, MD 21244 241 0 obj <> endobj MS Medicaid pharmacy contact and billing information (PCN/BIN) – effective Nov. 1, 2019; Mississippi Preferred Drug List (PDL) Opioid Frequently Asked Questions (FAQs) Pharmacy and Therapeutics (P&T) Committee; Pharmacy Resources ; Prior Authorization; Pharmacy Reimbursement; Office of Pharmacy Contact Information. Bill Medicaid (OHA or the CCO) last for all services except for Vaccines for Children administrations. Federal Poverty Level Notice. checking eligibility – HealthChoices – PA.gov. Wyoming Eligibility System Mailing Address. Phone: (601) 359-5253 – Press 1 if you are a Medicaid … Drug Cost Reimbursement for Physician Administered Drugs Use this worksheet to help with any issues you might have while transmitting to New York Medicaid. %%EOF �mnB�z�f��݌G�}�gd!�Ȋ��bNƨȲP~y�e�$LԠ,ޣ��4X�n�%{�|XmV�rG �].f/E�����.��[�f�,6�j�>���$A)ڙa���x�#�L�^� �Aeb;ZEXP�P%v���G?M5����>�h:M�2T�i:M�3�{R�;���z�a�.f*X��/�� The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2021 Medicare Part D plan sponsor. stream to submit upper case values on B1/B2 transactions. 0 Payer Name: Nebraska Medicaid Plan Name/Group Name: NEB01/NEBMEDICAID BIN: 013766 PCN: P063013766 Processor: Magellan Medicaid Administration Effective as of: 01/01/2012 NCPDP Telecommunication Standard Version/Release #: D.0 NCPDP Data Dictionary Version Date: June 2010 NCPDP External Code List Version Date: June 2010 %PDF-1.7 #��o�?�@1�b��X��} �_>��nݱ;��U�~y��s�f�a�}��-t��������l�`�b[��7�?o���y�}��4�b�������d�}ܭ Please call a Health Program Representative (HPR) at 1-866-608-9422 with Medicaid benefit questions. h�bbd```b``� �� ��,�"���"��"����`�X��n���r0�� ��@$�2��� ��9�A��*�8�d�' RBH��}��tU�=�T#�30�}0 ��^ 4 0 obj AHCCCS Health Plans BIN PCN Group Number PBM Phone Number AHCCCS FFS 001553 AZM OptumRx 855-577-6310 AHCCCS FFS – Secondary to Commercial 001553 AZM OptumRx 855-577-6310 AHCCCS FFS – Dual Eligibles for Covered OTC Prescriptions 001553 AZM OptumRx 855-577-6310 United Healthcare Community Plan (Acute, CRS, DD, LTC) 610494 4100 ACUAZ OptumRx 877-305-8952 … Amerigroup Community Care. Aetna … CVS Caremark Express. endstream endobj startxref <> 2021 List of Covered Drugs (Formulary) (pdf) for SCHA programs: Families and Children, MinnesotaCare, MSC+, SingleCare, and SharedCare; Minnesota Uniform Preferred Drug List effective January 1, 2021 (pdf) 2021 Prior Authorization Criteria – Medicaid (pdf) 2021 SCHA Pharmacy BIN and PCN (pdf) Limited Income Newly Eligible Transition Program (pdf) endobj 1. through the original fee-for-service Medicare program. Clarification of Unique BIN (or BIN/PCN) Requirements as of January 1, 2012 (v.11.12.10) (PDF) Home A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. BIN: 003858 | PCN: MA | Group: WKJA. 2 • Group Numbers MDMEDICAID – Medicaid MADAP – AIDS Administration (MADAP) MDKDP – Kidney Disease Program (KDP) MDBCCDT – Breast and Cervical Cancer Diagnosis and Treatment (BCCDT) • BIN Number – 610084 1. BIN Number: 014293. Members previously enrolled in PCN were automatically enrolled in Medicaid. The Texas Medicaid/CHIP Vendor Drug Program homepage has links to … <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Phone: 855-294-2127. Juvenile Justice. Bill OHA (FFS) for: Carve-out drugs for CCOs, drugs for OHP fee-for-service (“open card”) clients, drugs not covered by Medicare Part D, and drugs not included in the long-term care facility’s bundled rate. Suite 125. There is a new Medicaid program available for adults. Medicaid Pharmacy Pricing. Minnesota Health Care Programs providers billing for prescriptions for members in managed care organizations (MCOs) need to use the MCO's identification bin and PCN information. Plan Name/Group Name: Illinois Medicaid BIN: Ø178Ø4 PCN: ILPOP Processor: Change Healthcare (CHC) Effective as of: March 27, 2Ø17 NCPDP Telecommunication Standard Version/Release #: D.Ø NCPDP Data Dictionary Version Date: July 2ØØ7 NCPDP External Code List Version Date: July 2Ø13 Contact/Information Source: 1-877-782-5565 Certification Testing Window: Certification Contact … People who are deaf may call for assistance: TTY (800) 253-0799. Georgia Families® Quick Reference Guide – Georgia Medicaid. Xerox … Cheyenne, WY 82001. <>/Metadata 8878 0 R/ViewerPreferences 8879 0 R>> Change Healthcare Processor Control Number (PCN)/Benefit Identification Number (BIN): PCN Number: WYOPOP. The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2020 Medicare Part D plan sponsor. 3 0 obj Kentucky Medicaid BIN/PCN and Group Numbers. Wyoming Eligibility System . A letter was mailed to each member with more information. Payer Name: Florida Medicaid Date: 05/13/2011 Plan Name/Group Name: FL100/FLMedicaid BIN: Ø13352 PCN: PØ35Ø13352 Processor: Magellan Medicaid Administration Effective as of: TBD NCPDP Telecommunication Standard Version/Release #: D.0 NCPDP Data Dictionary Version Date: June 2010 NCPDP External Code List Version Date: June 2010 The segment summaries included below list the mandatory data fields. h�b```�VV�� ��ea�X�@���Y�quû�;$[D�q�d�gvLP�Ȑ��L@J�+�u/s���W����}ý������/a��KĎq/f�޸����/ ��5l��͇���m(�au�_�Ӊ���⠚����.|.�N,���>p� /@j������M���Y8L����f�m>vpOC� �|~�O��:�xV����E��K�%�9�qb³�J�5R'�~6ek�x0�&8�)�! C=F��Hòvv�8 # e��K������_��0j7�a��^¯ ���P��ܯ���00� } �׻��0�Q�'����=��yLH3�� > ��ys� ` ^B % I endstream endobj 0. Healthchoice MCOs relations support for legacy Medicaid will continue to be handled by the fiscal... Ncpdp ) standard Version �Ẇ�l�go��� ` �鴝? �Ẇ�l�go��� ` �鴝 values as defined under D.Ø. Call Medicaid 's main switchboard at ( 334 ) 242-5000 for assistance: (... 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