POS Pharmacy Billing. Payer Tables. Office of Information Technology Division of Information Resource Management Albuquerque, New Mexico
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1 POS Pharmacy Billing Payer Tables Office of Information Technology Division of Information Resource Management Albuquerque, New Mexico
2 Table of Contents 1.0 Aetna Argus Caremark Express Scripts HealthTrans Prescription Solutions Prime Therapeutics Medicare Part D Commercial Medco Medimpact SXC SAV-RX
3 1.0 Aetna BIN PCN Health Plan / Aetna Customer Name Aetna MEDDAET Medicare Part D MEDDAET Medicare Advantage Part D PARTBAET Medicare Advantage Only (Part B Only) 2
4 2.0 Argus BIN PCN Health Plan / Argus Customer Name D d/ b /a Medtipster (Added 12/1) D Pharmacy Benefits (Added 12/20/11) Adjudicated Marketing AmeriHealth Advantage (Added ) Argus Prescription Discount Program (Added 12/1) BCBS of Delaware BSCA BSCA Commercial BSCA Local MA-PD BSCA PDP Blue Cross Blue Shield Northern Alliance (Added ) CareFirst CareFirst CIGNA Great West Commercial CIGNA Great West TPA CIGNA International CIGNA Medicare PDP [Part D] CIGNA Pharmacy Services Contra Costa Health Plan Contra Costa Select Care MA-PD Essence Health Plan (Added 12/1) Essence Health Plan (Added ) FutureScripts PDP (Added 12/1) FutureScripts Secure (Added ) FutureScripts (added ) FutureScripts (added ) FutureScripts (added ) Gateway Health Plan (Added ) Gateway Health Plan MA-PD (Added ) Geisinger Health Plan Geisinger Health Plan MA-PD Geisinger Health Plan Gold Rx/PDP (Added ) Health Partners (Added ) HTH Medicare Part D (Added 12/15) HTH Medicare Part D MA (Added 12/15) Humana (Commercial) Humana LI NET Humana PDP 3
5 BIN PCN Health Plan / Argus Customer Name Indiana University Health Indiana University Health Plans Indiana University Health Plans Part-B(Added ) Inland Empire Health Plan (IEHP) (Added ) Inland Empire Health Plan (Dual Choice) (Added ) KelseyCare Advantage MAPD (Added 12/15) KelseyCare Advantage MA (Added 12/15) Kentucky Retirement System (Added 12/15) Kern Health Systems Keystone Mercy Health Plan KMHP Lovelace Health Systems, Inc. (Added ) Lovelace Health Plan, Inc. MA-PD (Added ) MCS Medicare Part D (Added 12/15) MCS Medicare MA (Added 12/15) MCS Med D Platino (Added 12/15) MDWise Medi-CareFirst MercyCare Insurance Corporation (Added 12/1) Missouri MODOT Medicare D (Added 12/15) Neighborhood Health Plan of Rhode Island New Benefits Passport Advantage (Added ) Passport Health Plan Physicians Plus Insurance Corporation (PPIC) (Added 12/1) Priority Health (Added 12/1) Priority Medicare & Medicare Plus (Added 12/1) Priority Medicare Rx (Added 12/1) Providence Health Plan (Added 12/1) Providence Medicare Extra (Added 12/1) Providence Pharmacy Bridge Program (Added 12/1) RxEDO (Added ) Scott and White Scott and White HMO Scott and White PBM Scott and White Senior Care Rx MA-PD Select Health State of California PBM: CDRC DAPO & CDCR DJJPO Upper Peninsula Health Plan (UPHP) Medicare Part D (Added 12/15) Valley Baptist Health Plan ASO Valley Baptist Health Plan HMO Vantage Health Plan Med-D (Added 12/15) 4
6 BIN PCN Health Plan / Argus Customer Name VRx 5
7 3.0 Caremark BIN PCN Health Plan / Caremark Customer Name ADV Legacy ADV MEDDADV Legacy ADV MEDDPCS Legacy PCS PCS Legacy PCS FEPRX FEP CRKblankblank Legacy CRK PC2 Legacy PHC MDP Legacy PHC HP Legacy PHC FCHP Legacy PHC COMHP Legacy PHC AHP Legacy PHC PC3 Legacy PHC PC5 Legacy PHC HPI Legacy PHC MD2 Legacy PHC MD2FCHP Legacy PHC MD2MP Legacy PHC FALLON Legacy PHC AI Legacy PHC Legacy PHC U07, U12 Legacy PHC TDI Legacy PHC SSP Legacy PHC CAP Legacy PHC EBMS Legacy PHC CAP Legacy PHC Legacy AmeRX Legacy AmeRX Legacy AmeRX Legacy AmeRX Legacy AmeRX Legacy AmeRX Legacy AmeRX Legacy AmeRX 6
8 4.0 Express Scripts BIN PCN Health Plan /Express Scripts Customer Name A4 Express Scripts Medicare Express Scripts, Inc. Express Scripts, Inc. - Department of Defense (DoD) 4ØØØ23 HIP Medicare Part D Ø118ØØ 1199 SEIU Ø13337 Connecticare (CCI) Medicare Part D Ø13344 GHI Medicare Part D ØØ2ØØ5Ø4Ø3 HIP Medicare Part D ØØ2ØØ5Ø4Ø SEIU ØØ2ØØ8Ø229 Connecticare (CCI) Medicare Part DØØ2ØØ8Ø229 GHI Medicare Part D Emblem Health - Medicare 7
9 5.0 HealthTrans BIN PCN HT ADP VPC HT HT HT HT HT HT HT HT HT HT HT 11867(UNA) HTALS HT HT HT HT HT HT HT HT HT AVIA HT HMC NWCMS/ NWHDP OHCMS NCCMS/ NCHDP MACMS/ MAHDP COCMS/COCMSS/COHDP SCCMS/ SCHDP HICMS GACMS 8
10 6.0 Prescription Solutions Bank Identification Number (BIN) Processor Control Number (PCN) Effective or Go-Live Date Payer Sheet /13/2011 Solutions Net ( )Document # /18/2011 Solutions Net ( )Document # ALL 10/20/2011 Solutions Net ( )Document # PRX /21/2011 Solutions Net ( )Document # /25/2011 Solutions Net ( )Document # MEDD 10/27/2011 Solutions Net ( )Document # MEDD 10/27/2011 Solutions Net ( )Document # MEDD 10/27/2011 Solutions Net ( )Document # /27/2011 Solutions Net ( )Document #2403 9
11 7.0 Prime Therapeutics 7.1 Medicare Part D BIN PCN Health Plan / Prime Therapeutics Customer Name Ø14897 MBG BCBS of Alabama Blue Advantage (MA-PD) RPD BCBS of Alabama BlueRx (PDP) BCBS of Tennessee BlueRx PDP Ø12833 MEDDPRIME BCBS of Florida MEDDPRIMEG BCBS of Florida Employer Groups Ø11552 MPGNM HISC BCBS of New Mexico Employer Groups PDGNM HISC BCBS of New Mexico Employer Groups PDP Region 26 PDPNM HISC BCBS of New Mexico PDP Region 26 MPGTX HISC BCBS of Texas Employer Groups PDGTX HISC BCBS of Texas Employer Groups PDP Region 22 PDPTX HISC BCBS of Texas PDP Region 22 PDGIL HISC BCBS of Illinois Employer Groups PDP Region 17 PDPIL HISC BCBS of Illinois PDP Region 17 61Ø455 MPDBP BCBS of Minnesota (Secure Blue (MSHO)) PDGOK Blue Plus Medicare Advantage BCBS of Oklahoma (Employer Groups PDP Region 23) PDPOK Blue Plus Medicare Advantage BCBS of Oklahoma PDP Region 23 MPDPH Blue Plus Medicare Advantage PrimeWest Health Special Needs BasicCare (SNBC) MPDPW Blue Plus Medicare Advantage PrimeWest MSHO MPDSA Blue Plus Medicare Advantage South Country Health Alliance- AbilityCare (SNBC) MPDSM Blue Plus Medicare Advantage South Country Health Alliance (MSHO) PDP25 BCBS of Iowa PDP Region 25 BCBS of South Dakota PDP Region 25 Northern Plains Alliance BCBS of Wyoming PDP Region 25 Northern Plains Alliance BCBS of Minnesota PDP Region 25 Northern Plains Alliance BCBS of Montana PDP Region 25 Northern Plains Alliance BCBS of North Dakota PDP Region 25 Northern Plains Alliance BCBS of Nebraska PDP Region 25 MPD19 Northern Plains Alliance BCBS of Minnesota Employer Groups MA-PD Region 19 10
12 7.2 Commercial BIN PCN Health Plan / Prime Therapeutics Customer Name ØØ4915 Not Required BCBS of Alabama WRI BCBS of Alabama Work Related Injury Benefit Ø12833 FLBC BCBS of Florida Ø11552 ILDR BCBS of Illinois ILSC BCBS of Illinois (Blue Script) NMDR BCBS of New Mexico 1215 BCBS of Oklahoma (Drug Card) 1217 BCBS of Oklahoma (Comp Card) BCTX BCBS of Texas 61Ø455 KSBCS BCBS of Kansas PGIGN BCBS of Minnesota PGNB1 or PGIGN BCBS of Minnesota (Cenex Harvest) CARVE NON BCBS Clients (Carve Out Groups) HMBC BCBS of Montana NDBCS BCBS of North Dakota NORID BCBS of North Dakota (Noridian) RXNEB BCBS of Nebraska PPNI1 BCBS of Nebraska (CITY OF OMAHA PF DISABLED) UMEMP University of Minnesota UPlan 8ØØØØ1 WYBCS BCBS of Wyoming 11
13 8.0 Medco BIN PCN Health Plan / Medco Unsuppressed blank Commercial 313, PRODUR1 ACS Maryland Medicaid 313, blank Member Balance Inquiry 313,367 12
14 9.0 Medimpact BIN Health Plan / Medimpact Customer Name MEDIMPACT MEDIMPACT MEDIMPACT DESTINATION RX AWA/AGILITY SUNRX SUNRX APEX AFFINITY/MEDIMPACT APEX AFFINITY/MEDIMPACT AGELITY/SUN RX SUNRX ROCKFORD HEALTH PLAN SCRIPSOLUTIONS D AGELITY/SUN RX HEB RXTRA ADVANTAGE/MEDIM BIOSCRIP 13
15 10.0 SXC BIN Health Plan / SXC informedrx National informedrx National informedrx National informedrx National informedrx National informedrx National informedrx National informedrx National informedrx National Kroger Prescription Plans American Health Care American Health Care Welldyne 14
16 11.0 SAV-RX BIN SAV-RX SAV-RX SAV-RX Health Plan / SAV-RX 15
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