POS Pharmacy Billing Payer Tables Office of Information Technology Division of Information Resource Management Albuquerque, New Mexico
Table of Contents 1.0 Aetna... 2 2.0 Argus... 3 3.0 Caremark... 6 4.0 Express Scripts... 7 5.0 HealthTrans... 8 6.0 Prescription Solutions... 9 7.0 Prime Therapeutics... 10 7.1 Medicare Part D... 10 7.2 Commercial... 11 8.0 Medco... 12 9.0 Medimpact... 13 10.0 SXC... 14 11.0 SAV-RX... 15 1
1.0 Aetna BIN PCN Health Plan / Aetna Customer Name 610502 00670000 Aetna 610502 MEDDAET Medicare Part D 610502 MEDDAET Medicare Advantage Part D 610502 PARTBAET Medicare Advantage Only (Part B Only) 2
2.0 Argus BIN PCN Health Plan / Argus Customer Name 610209 5460000 4D d/ b /a Medtipster (Added 12/1) 600428 1990000 4D Pharmacy Benefits (Added 12/20/11) 600428 5080000 Adjudicated Marketing 12353 3660000 AmeriHealth Advantage (Added 11.7.11) 600428 3020000 Argus Prescription Discount Program (Added 12/1) 600428 3010000 BCBS of Delaware 600428 2960000 BSCA 600428 1910000 BSCA Commercial 12353 1920000 BSCA Local MA-PD 12353 3510000 BSCA PDP 600428 3800000 Blue Cross Blue Shield Northern Alliance (Added 11.7.11) 11834 3050000 CareFirst 11834 3000000 CareFirst 600428 5180000 CIGNA Great West Commercial 600428 5190000 CIGNA Great West TPA 600428 2160000 CIGNA International 12353 3490000 CIGNA Medicare PDP [Part D] 600428 2150000 CIGNA Pharmacy Services 600428 3970000 Contra Costa Health Plan 12353 4740000 Contra Costa Select Care MA-PD 600428 2750000 Essence Health Plan (Added 12/1) 12353 2750000 Essence Health Plan (Added 12.22.11) 12353 3820000 FutureScripts PDP (Added 12/1) 12353 3820000 FutureScripts Secure (Added 12.22.11) 600428 3820000 FutureScripts (added 12.20.11) 600428 3840000 FutureScripts (added 12.20.11) 600428 4820000 FutureScripts (added 12.20.11) 600428 2710000 Gateway Health Plan (Added 11.14.11) 12353 3740000 Gateway Health Plan MA-PD (Added 11.14.11) 600428 2040000 Geisinger Health Plan 12353 3640000 Geisinger Health Plan MA-PD 12353 4170000 Geisinger Health Plan Gold Rx/PDP (Added 12.22.11) 600428 2530000 Health Partners (Added 12.20.11) 15764 5910000 HTH Medicare Part D (Added 12/15) 15764 5912961 HTH Medicare Part D MA (Added 12/15) 610649 3190000 Humana (Commercial) 015599 5440000 Humana LI NET 015581 3200000 Humana PDP 3
BIN PCN Health Plan / Argus Customer Name 600428 5510000 Indiana University Health 600428 5270000 Indiana University Health Plans 600428 5270000 Indiana University Health Plans Part-B(Added 12.22.11) 600428 2550000 Inland Empire Health Plan (IEHP) (Added 11.2.11) 12353 4110000 Inland Empire Health Plan (Dual Choice) (Added 11.2.11) 15764 5900000 KelseyCare Advantage MAPD (Added 12/15) 15764 5900001 KelseyCare Advantage MA (Added 12/15) 15764 5920000 Kentucky Retirement System (Added 12/15) 600428 4970000 Kern Health Systems 600428 1940000 Keystone Mercy Health Plan KMHP 600428 2490000 Lovelace Health Systems, Inc. (Added 11.14.11) 12353 3730000 Lovelace Health Plan, Inc. MA-PD (Added 11.14.11) 15764 5940000 MCS Medicare Part D (Added 12/15) 15764 5948780 MCS Medicare MA (Added 12/15) 15764 5950000 MCS Med D Platino (Added 12/15) 600428 3210000 MDWise 12353 3030000 Medi-CareFirst 600428 2740000 MercyCare Insurance Corporation (Added 12/1) 15764 5930000 Missouri MODOT Medicare D (Added 12/15) 600428 5280000 Neighborhood Health Plan of Rhode Island 610225 5591000 New Benefits 12353 3650000 Passport Advantage (Added 11.7.11) 600428 2920000 Passport Health Plan 600428 710000 Physicians Plus Insurance Corporation (PPIC) (Added 12/1) 600428 750000 Priority Health (Added 12/1) 12353 3690000 Priority Medicare & Medicare Plus (Added 12/1) 12353 3700000 Priority Medicare Rx (Added 12/1) 600428 1420000 Providence Health Plan (Added 12/1) 12353 3300000 Providence Medicare Extra (Added 12/1) 600428 5230000 Providence Pharmacy Bridge Program (Added 12/1) 610220 3980000 RxEDO (Added 11.14.11) 610141 3270000 Scott and White 610141 2500000 Scott and White HMO 610141 2510000 Scott and White PBM 12353 3710000 Scott and White Senior Care Rx MA-PD 600428 2180000 Select Health 600428 5540000 State of California PBM: CDRC DAPO & CDCR DJJPO 15764 5960000 Upper Peninsula Health Plan (UPHP) Medicare Part D (Added 12/15) 610141 5580000 Valley Baptist Health Plan ASO 610141 5570000 Valley Baptist Health Plan HMO 15764 5970000 Vantage Health Plan Med-D (Added 12/15) 4
BIN PCN Health Plan / Argus Customer Name 610245 5490000 VRx 5
3.0 Caremark BIN PCN Health Plan / Caremark Customer Name 004336 ADV Legacy ADV 004336 MEDDADV Legacy ADV 610415 MEDDPCS Legacy PCS 610415 PCS Legacy PCS 610239 FEPRX FEP 610029 CRKblankblank Legacy CRK 610468 PC2 Legacy PHC 610468 MDP Legacy PHC 610468 HP Legacy PHC 610468 FCHP Legacy PHC 610468 COMHP Legacy PHC 610468 AHP Legacy PHC 610468 PC3 Legacy PHC 610468 PC5 Legacy PHC 610468 HPI Legacy PHC 610468 MD2 Legacy PHC 610468 MD2FCHP Legacy PHC 610468 MD2MP Legacy PHC 610468 FALLON Legacy PHC 006144 AI Legacy PHC 004245 Legacy PHC 610449 U07, U12 Legacy PHC 610474 TDI Legacy PHC 610474 SSP Legacy PHC 610474 CAP Legacy PHC 610474 EBMS Legacy PHC 603604 CAP Legacy PHC 610473 Legacy AmeRX 610475 Legacy AmeRX 007093 Legacy AmeRX 012189 Legacy AmeRX 013303 Legacy AmeRX 014046 Legacy AmeRX 610130 Legacy AmeRX 610477 Legacy AmeRX 6
4.0 Express Scripts BIN PCN Health Plan /Express Scripts Customer Name 003858 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 ØØ2ØØ5Ø4Ø3 1199 SEIU ØØ2ØØ8Ø229 Connecticare (CCI) Medicare Part DØØ2ØØ8Ø229 GHI Medicare Part D Emblem Health - Medicare 7
5.0 HealthTrans BIN PCN 003452 HT 004519 ADP VPC 004781 HT 005285 HT 005491 HT 009117 HT 009951 HT 009992 HT 010553 HT 011230 HT 011248 HT 011677 HT 011792 HT 11867(UNA) HTALS 011867 HT 013469 HT 013907 HT 014186 HT 014582 HT 014632 HT 014681 HT 015566 HT 610086 HT 610550 AVIA 011297 HT 610606 HMC 011230 NWCMS/ NWHDP 011248 OHCMS 011842 NCCMS/ NCHDP 011859 MACMS/ MAHDP 011255 COCMS/COCMSS/COHDP 011172 SCCMS/ SCHDP 011214 HICMS 011222 GACMS 8
6.0 Prescription Solutions Bank Identification Number (BIN) Processor Control Number (PCN) Effective or Go-Live Date Payer Sheet 610494 9999 10/13/2011 Solutions Net (1.800.797.9793)Document #2205 610494 3333 10/18/2011 Solutions Net (1.800.797.9793)Document #2205 610127 ALL 10/20/2011 Solutions Net (1.800.797.9793)Document #2205 15243 PRX1000 10/21/2011 Solutions Net (1.800.797.9793)Document #2205 610097 9999 10/25/2011 Solutions Net (1.800.797.9793)Document #2403 11875 MEDD 10/27/2011 Solutions Net (1.800.797.9793)Document #2403 14848 MEDD 10/27/2011 Solutions Net (1.800.797.9793)Document #2403 15913 MEDD 10/27/2011 Solutions Net (1.800.797.9793)Document #2403 610097 8888 10/27/2011 Solutions Net (1.800.797.9793)Document #2403 9
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
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
8.0 Medco BIN PCN Health Plan / Medco Unsuppressed 610014 blank Commercial 313,367 610084 PRODUR1 ACS Maryland Medicaid 313,367 610056 blank Member Balance Inquiry 313,367 12
9.0 Medimpact BIN Health Plan / Medimpact Customer Name 003585 MEDIMPACT 005500 MEDIMPACT 2 005518 MEDIMPACT 3 010439 DESTINATION RX 013105 AWA/AGILITY 013675 SUNRX 013709 SUNRX 015441 APEX AFFINITY/MEDIMPACT 015517 APEX AFFINITY/MEDIMPACT 610182 AGELITY/SUN RX 610193 SUNRX 610610 ROCKFORD HEALTH PLAN 610679 SCRIPSOLUTIONS D 610711 AGELITY/SUN RX 015400 HEB RXTRA ADVANTAGE/MEDIM 900020 BIOSCRIP 13
10.0 SXC BIN Health Plan / SXC 610593 informedrx National 610011 informedrx National 003650 informedrx National 610619 informedrx National 601577 informedrx National 610527 informedrx National 004469 informedrx National 014211 informedrx National 010876 informedrx National 012882 Kroger Prescription Plans 610118 American Health Care 014872 American Health Care 008878 Welldyne 14
11.0 SAV-RX BIN 006558 SAV-RX 008563 SAV-RX 012684 SAV-RX Health Plan / SAV-RX 15