Bin 004336 payer sheet

Payer sheet

Bin 004336 payer sheet

Please refer to that for Part D submission requirements. This payer sheet refers to Commercial Other Payer Amount Paid ( OPAP) Billing. GENERAL INFORMATION. bin 0 Payer Sheet CLAIM REVERSAL, RESPONSE. 471- 5E Other Payer Reject Count Max of.

sheet 004336 NCPDP Standard sheet 004336 Payer Sheet. Payer Name: Independent Health NCPDP VERSION D CLAIM BILLING/ CLAIM REBILL TEMPLATE 1. bin NCPDP Payer Sheet Department of Health Care Services ( DHCS) Version Number: 5. 1 REQUEST CLAIM BILLING/ CLAIM REBILL PAYER SHEET TEMPLATE * * Start 004336 of Request Claim Billing/ Claim Rebill sheet ( B1/ B3) Payer Sheet Template* * GENERAL INFORMATION Payer Name: CIGNA Date: 01/ 01/ Plan Name/ Group Name: Cigna Pharmacy Services BIN: 600428 PCN:. This payer sheet refers to Primary Commercial Billing. Bin 004336 payer sheet.

Payer Specification Sheet for Prime Therapeutics’ Medicare Part D Clients. This payer sheet refers to Medicare Part D Primary Billing and Medicare as Secondary. RW Required if Other Payer Amount Paid QualifierHC) is used. 34Ø - 7C 004336 OTHER PAYER ID R Other payer BIN 443 - E8 OTHER PAYER DATE bin R 341 - HB OTHER PAYER AMO UNT bin PAID COUNT Maximum count of 9. com under the Health Care Professionals link for additional payer sheets. The following is a summary of our new requirements. If not, go to step 2.

Field # NCPDP Field Name Value 004336 Payer Usage Payer Situation 1Ø1- A1 BIN NUMBER Multiple. the MedImpact Part D Bin. Submit an E1 Transaction Submit a sheet query to Medicare’ s online eligibility query system. BIN and PCN Values. 610415,,, 004245. • If the E1 query returns BIN/ PCN, submit the claim to that Medicare Part D plan. Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1- A1 BIN NUMBER M BIN listed 004336 in General Information. NCPDP VERSION D CLAIM BILLING. 004336 0 Payer Sheet Medicare Part D.

BIN: 61Ø442 For Claim Billing. SEGMENT if Other Payer does not have a BIN due to offline billing. 339 - 6C OTHER PAYER ID QUALIFIER R Required if Other Payer ID ( 34Ø - 7C) is bin used. The items highlighted in the payer sheet illustrate the updated processing rules. If the patient has a Medicare Part D plan ID card a Medicare Part D plan letter with 4Rx data, submit claims to the Part D payer. 338‐ 5 other payer coverage type rw rw when required by plan 339‐ 6 other bin payer id qualifier rw 03 = bin 340- 7c other bin payer id rw bin of other payer 443- e8 004336 other payer date rw when required by plan 341- hb other payer amount paid count rw # of bin occurrences. There is separate Part D Payer sheet Sheet. Bin 004336 payer sheet. 1Ø1- A1 BIN Number 004336, 012320.

CATAMARAN NON – MEDICARE PART D PAYER SHEET. To prevent point of service disruption the RxGroup must be submitted on all claims reversals. Payer Usage Payer Situation 1Ø1 004336 - A1 BIN NUMBER 009737 M. 1Ø1- A1 BIN Number 610415,,,. INDEPENDENT HEALTH D.
REVISIONS in Table of Contents.

Sheet payer

BIN PCN RxGrp Member ID# 004336 MEDDADV RX6270 11 Digit number consisting of: 9 Digit Number and 2 Digit Person Code PAYER SHEET To view the CVS Caremark Payer Sheet for RxBIN 004336 go to www. At the bottom of the home page, select “ For Pharmacist and Medical Professionals" to view the various payer sheets. Input your NCPDP# or other user name into the User Name field, then click " Password Reminder" and your password will be sent to the email address on file. If you are an APCI member and have other issues accessing the site,.

bin 004336 payer sheet

Using the Payer Sheet Template Implementation Guide + The BIN/ IIN and PCNs are listed on the PBM/ processor/ plan’ s Payer Sheets for trading partners to know the proper identifiers for routing transactions. Michigan Medicaid Payer Specification.