Bin 003858 Pcn A4

Region BIN PCN/ Group Help Desk Dept of Defense (DoD Tricare) Express Scripts National 003858 gp- ESI 866/684-4466 Destination Rx - Agelity Agelity National 010439 AG 800-847-7147 Diversified Pharm Svcs (DPS) Express Scripts National 003858 gp- ESI 877/776-8735 Driscoll Children's Health Plan Express Scripts TX only 003858 gp- ESI 361/904-0955. Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. PO Box 30757 Salt Lake City. Find your plan's BINs, PCNs, and RxGroups!. Q: Can my insurance ID card be mailed to my permanent address? A: Medical ID cards are available electronically only. 1Ø1-A1 BIN NUMBER 610106 M BIN for PBM Plus 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M Claim Billing, Claim Rebilling 1Ø4-A4 PROCESSOR CONTROL NUMBER PBMOCE M PCN for PBM Plus 1Ø9-A9 TRANSACTION COUNT 01 = One Occurrence M 2Ø2-B2 SERVICE PROVIDER ID QUALIFIER 01 – National Provider ID. Rx Bin: 003858 Rx Group: CN3A PCN: A4 Medicare Advantage with Prescription Drug (MAPD) Tax ID: 06‐1537522 Rx Bin: 01337 Rx Group: CN3A PCN: 0020080229 Harvard Pilgrim Health Care PO Box 699183 Quincy, MA 02269‐9183 Tax ID: 04‐2452600 RX Bin: 003585 RX Group: 35000. com Member Customer Service: 800-706-1754 Pharmacist Use Only: 800-922-1557 Providers are reimbursed pursuant to the terms of the Plan Document up to the Reasonable and Allowable Amount (subject to reference pricing). 0 New/Modified Reports Menu. Edit: I realize my post won't really be helpful, but I'll just use it as a place holder in case you still need it tomorrow. Rx BIN: 003858 Rx PCN: A4 Rx GROUP: 6MEDICA For benefits, use a Balance by Medica network provider. New features for your employees and dependents. 0000004568 00000 n Welcome to Express Scripts! Use your drug discount card to save on medications for the entire family ‐ including your pets. You may go to our website to search for an in-network pharmacy near your. 1Ø1-A1 BIN Number See BIN/PCN table, above M 1Ø2-A2 Version Release Number DØ=Version D. Rx Bin: 003858 Rx Group: CN3A PCN: A4 Medicare Advantage with Prescription Drug (MAPD) Tax ID: 06‐1537522 Rx Bin: 01337 Rx Group: CN3A PCN: 0020080229 Harvard Pilgrim Health Care PO Box 699183 Quincy, MA 02269‐9183 Tax ID: 04‐2452600 RX Bin: 003585 RX Group: 35000. The Customer Service number is (855) 383-7248, press 1 for IngenioRx. BIN: 015251(OPTUMRx) 003858 PCN: PRX2000 A4 ID: HB224289455 (can be used for all patients – one (1) meter/patient) Member’s UinCare ID Number from card RxGroup: PRX2000 WFWA Pharmacists needing assistance processing a claim for meters should contact OPTUMRx at 1. Welcome to Express Scripts! We’re the manager of your PICA prescription benefit for New York City Office Of Labor Relations Employee. This section provides instructions on the new/modified reports which can help you. Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. Click here for the first page (E0654 - H2235) , second page (H2237 - H3959) , fourth page (H5928 - H8634) and fifth page (H8634 - S9701). Group: MASA. IRX : New Member ID. Bin: 003858. Also, reversal parameters under the "Claim" segment must be turned on to send "Other Coverage Code". BIN: 015251(OPTUMRx) 003858 PCN: PRX2000 A4 ID: HB224289455 (can be used for all patients - one (1) meter/patient) Member's UinCare ID Number from card RxGroup: …. Farm Bureau Essential Rx and Select Rx PDPs (AL, TN): 610011 CTRXMEDD Leon Medical Centers Health Plans - Leon Cares HMO (certain FL counties only): …. 0 General Options" tab, as well you must turn on the "Misc Option" to send Field "505-F5" (Always Send Patient Pay Amount). Medical Claims: Medica Individual and Family Business PO Box …. PHARMACY USE ONLY (please follow the steps below to. BIN 003858, PCN A4, Group SANFRX Medicaid Managed Care BIN, PCN, and Group 1/1/2019 through 12/31/2019 (pharmacy services carved out of managed care starting 1/1/2020) BIN 610011, PCN IRX, Group SHNNDMEDI If you have pharmacy questions, you may email them to [email protected] Compounded prescriptions provided to Medicaid beneficiaries paid by MCOs using the BIN/PCN table below e. Drug formulary, policy and forms. I work tomorrow morning so I can check and see what the PCN/BIN is that auto-populates if you still need it. Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 Urgent Care Copay: $50 Physical Therapy Copay: $20 HEALTH PLAN: MEDICAL RX Plan: Express Scripts RxGRP: GH3A *AdvantageCare Physicians ER copay*: $150 (see details on back). com VISION. 2088 for CHIP or 866. Bin: 003858 Personal Code: 01 PCN: A4 Group: CCVVAACTIVE. BIN: 003858. Rx Bin: 003858 PCN: A4 Rx Group: EGYPTRX www. Benefits/Claims - Medica: 1-800-458-5512. BIN: 610591 PCN: Rx881A Group: ADV Pharmacy claims may be submitted to CVS/Caremark via the latest NCPDP D. You may go to our website to search for an in-network pharmacy near your. PO Box 30757 Salt Lake City. BIN #: 003858 PCN #: A4 RxGrp #: Subscriber ID # or SSN Patient's Date of Birth Please enter the listed details below to process the claim. BIN: 015251(OPTUMRx) 003858 PCN: PRX2000 A4 ID: HB224289455 (can be used for all patients - one (1) meter/patient) Member's UinCare ID Number from card RxGroup: …. Farm Bureau Essential Rx and Select Rx PDPs (AL, TN): 610011 CTRXMEDD Leon Medical Centers Health Plans - Leon Cares HMO (certain FL counties only): …. » Bin Number: 003858 » PCN: A4 » Rx Group: TJC83VA » Member ID Number: This is the same ID number found on the member's Anthem medical card, but without the "TJA" prefix. Commercial and HIX : Processor Control Number (PCN) A4. Benefits/Claims – Medica: 1-800-458-5512. RxBIN 003858 RxPCN A4 RxGrp APNA Issuer 9151014609 (80840) ID CWK000100002 Name JOHN Q SAMPLE RxBIN 003858 RxPCN A4 RxGrp APNA ID CWK000100002 Name JOHN Q SAMPLE Here are your new PICA ID cards. Submit member ID minus first three alpha characters. 004336 MCAIDADV RX5435 Molina coordination of benefits (COB) members 013089 COMESEGADV Group per … PCN. 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. TRICARE EXPRESS SCRIPTS 5. IRX : New Member ID. 1Ø1-A1 BIN NUMBER Multiple M BIN’s listed in General Information Section 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1 M 1Ø4-A4 PROCESSOR CONTROL NUMBER Multiple M PCN’s listed in General Information Section 1Ø9-A9 TRANSACTION COUNT Ø1-Ø4 M Up to 4 transactions per B1 transmissions accepted. the BIN and PCN on their customer profile to access their benefits in 2021. Chiropractic Care. Created Date: 10/3/2019 3:00:03 PM. Policy Number: Same as the medical BCBSMA ID number. BIN: 001553 PCN: GAM The two dedicated phone lines for the Georgia Medicaid FFS account at SXC are as follows: Technical Support Clinical and Prior Authorization support 866-525-5826 866-525-5827 (phone) 888-491-9742 (fax) The technical support line at SXC opened for pharmacists on December 18, 2006. Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing For eligibility information, plan policy Express Scripts (800) 824-0898 …. PLAN BIN PCN GROUP NUMBER Amerigroup 020107 CM WKHA Apple Health Fee-For-Service (FFS) 610706 WAPROD N/A Community Health 003858 A4 CHWA Coordinated Care of …. rx group: rxs4cis m d rx. BIN Number 610014 610014 003858 600428 PCN Number Per card, cannot be 0s 06330000Per card, cannot be 0s A4 Group Number CVTYWVM THPWVMC WFWA. Rx BIN: 003858 Rx PCN: A4 Rx GROUP: 6MEDICA For benefits, use a Balance by Medica network provider. RxBIN 003858 RxPCN A4 RxGrp APNA Issuer 9151014609 (80840) ID CWK000100002 Name JOHN Q SAMPLE RxBIN 003858 RxPCN A4 RxGrp APNA ID CWK000100002 Name JOHN Q SAMPLE …. BIN: 003858 PCN: A4 Group: VETERAN : Urgent Care BIN: 003858 Person Code: 01 PCN: A4 Group: VAPC3RX. Learn more about the MyBlue Member App and review the FAQs. Commercial and HIX : Processor Control Number (PCN) A4. If there is a Part D BIN/PCN/Group missing that you would like us to add, please shoot us an email at [email protected] 0 017076 January 1, 2019 D. 0000004568 00000 n Welcome to Express Scripts! Use your drug discount card to save on medications for the entire family ‐ including your pets. data element to be sent with all claims for this bin#. Rx Bin: 003858 PCN: A4 Rx Group: EGYPTRX www. X < Z > > a m m z co co z z < z > z '0 z c CD < < < o CD CD CD CD z a X CD CD z < z co O > < cn < Z CD CD CD co CD co c < Z > Z < co • co CD < c: < z. Chiropractic Care. PHARMACY USE ONLY (please follow the steps below to. BIN: 001553 PCN: GAM The two dedicated phone lines for the Georgia Medicaid FFS account at SXC are as follows: Technical Support Clinical and Prior Authorization support 866-525-5826 866-525-5827 (phone) 888-491-9742 (fax) The technical support line at SXC opened for pharmacists on December 18, 2006. You may go to our website to search for an in-network pharmacy near your. rx pcn: a4. See FAQ below. Maintenance drugs are medicines used for long-term health conditions like asthma, heartburn, high blood pressure, allergies. Member Services: 800-711-0917 County of Dekalb * Effective 1/1/2019 * Pharmacist. 0 M 1Ø3-A3 Transaction Code B1=Billing M 1Ø4-A4 Processor Control Number …. BIN 003858 PCN A4 Group# WFTA. I work tomorrow morning so I can check and see what the PCN/BIN is that auto-populates if you still need it. com Member Customer Service: 800-706-1754 Pharmacist Use Only: 800-922-1557 Providers are reimbursed pursuant to the terms of the Plan Document up to the Reasonable and Allowable Amount (subject to reference pricing). BIN#: 003858 PCN: A4 Group: PH6W Toledo Hospital OP Pharmacy 419-291-5418; Flower Hospital OP Pharmacy 419-824-1644; ProMedica Home Infusion 419-291-8247;Center for Health Services OP Pharmacy 419-291-8530; The Toledo Clinic OP Pharmacy 419-479-5800; CuraScript, Inc. 18 ©2020 Aetna Inc. Step 1: Enter BIN: 003858; Step 2: Person Code: 01; Step 3: Enter PCN: A4; Step 4: Enter Rx Group: VAPC3RX; Step 5: Enter 9-digit member ID: Patient SSN; Step 6: Enter Veteran’s date of birth (YYYYMMDD format) For questions, please call the Express Scripts Pharmacy Help Desk at 800-922-1557 (24/7). » Member Date of Birth; If you are still unable to fill a prescription, please call Express Scripts Customer Service, 24 hours a day, 7 days a week at 855-230-7775. PCN: NVT BIN: 610602 Medicare Part D (CompanionCare) plan members contact Navitus Customer Care. BIN: 004336: 003858: Person Code: N/A: 01: PCN: ADV: A4: Group: RX3841: VETERAN: Birth Date: N/A: Enter Veteran’s date of birth (CCYYMMDD format) Member ID: 10-digit Member ID* number on Veteran’s VA or Department of Defense ID card OR 17-digit internal control number (ICN) Veteran’s Social Security Number. Clinical and Prior Authorization support. Flu Shot Bin: 003858 Personal Code: 01 PCN: A4 …. They can be reached at 866-270-3877, TTY: 771 If members are at a pharmacy and without their ID card, the below information may be helpful: Member ID number PCN: EGWP BIN: 610602 Mail Service. services for benefit information. Rx Bin: 003858 Rx PCN: MD Rx Group: 2Medica. BIN #: 003858 PCN #: A4 RxGrp #: Subscriber ID # or SSN Patient's Date of Birth Please enter the listed details below to process the claim. 1Ø1-A1 BIN Number See BIN/PCN table, above M 1Ø2-A2 Version Release Number DØ=Version D. Step 1 Enter BIN: 003858 Step 2 Person Code: 01 Step 3 Enter PCN: A4 Step 4 Enter Rx Group: VAPC3RX Step 5 Enter 9 digit member ID: Patient SSN Step 6 Enter member's date of birth (CCYYMMDD format) If the Veteran does not have eligibility and prescription is related to an urgent care visit. 0000004568 00000 n Welcome to Express Scripts! Use your drug discount card to save on medications for the entire family ‐ including your pets. data element to be sent with all claims for this bin#. The following Medical Assistance (MA) Bulletin applies to 340B covered entities that bill the MA Fee-for-Service (FFS) program and/or a MA Program managed care organization (MCO) for drugs purchased under the 340B Drug Pricing Program and dispensed to MA program beneficiaries: MAB 99-13-08: 340B Drug Pricing Program Provider Requirements and. 003858 A4 WQWA United Healthcare 1-855-873-3493 610494 4900 ACUVA Magellan Complete Care 1-800-424-4524 016523 62282 VAMLTSS Optima Family Care 1-866-244-9113 610011 OHPMCAID n/a VA Premier 1-844-838-0711 009893 ROIRX n/a BIN, PCN and pharmacy helpdesk number, should you need to. X < Z > > a m m z co co z z < z > z '0 z c CD < < < o CD CD CD CD z a X CD CD z < z co O > < cn < Z CD CD CD co CD co c < Z > Z < co • co CD < c: < z. Pharmacy providers should ask members for an MCO identification card to verify MCO enrollment in addition to the Medicaid card. If you have any questions …. 1Ø1-a1 bin number 610014 m 1Ø2-a2 version/release number dØ m 1Ø3-a3 transaction code b1 m 1Ø4-a4 processor control number meddprime m 1Ø9-a9 transaction count 1 m 2Ø2-b2 service provider id qualifier 01 m 2Ø1-b1 service provider id npi m 4Ø1-d1 date of service m 11Ø-ak software vendor/certification id assigned when certified by. Farm Bureau Essential Rx and Select Rx PDPs (AL, TN): 610011 CTRXMEDD Leon Medical Centers Health Plans - Leon Cares HMO (certain FL counties only): 017010 CIMCARE CGLEONRX. 2088 for CHIP or 866. Page 4 of 5 Source: BCBSTX Medicaid Provider Manual A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an. PHARMACY USE ONLY (please follow the steps below to. Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage. Group: VAPC3RX If you go to a non-CCN participating pharmacy, you may be responsible for the cost of the medication and may seek reimbursement from VA. Learn more about the MyBlue Member App and review the FAQs. BIN 003858 PCN A4 Group# WFTA. Submit member ID minus first three alpha characters. Medicare Parts B, C and D-paid prescriptions (If available) 003858 A4 Group: PMDM PA PACE 002286 0000102286 or 0000682201 26 Enter the number of prescriptions delivered during the reporting period. Health Details: PLAN BIN PCN GROUP NUMBER Amerigroup 020107 CM WKHA Apple Health Fee-For-Service (FFS) 610706 WAPROD N/A Community Health 003858 A4 CHWA Coordinated Care of Washington, Inc. Learn more about the MyBlue Member App and review the FAQs. 1Ø1-A1 BIN Number See BIN/PCN table, above M 1Ø2-A2 Version Release Number DØ=Version D. Rx Bin Number: 003858: Rx PCN: A4: Rx Group Number WFLEET1: Member ID Number Your member ID is on your Wellfleet ID card. com Member Customer Service: 800-706-1754 Pharmacist Use Only: 800-922-1557 Providers are reimbursed pursuant to the terms of the Plan Document up to the Reasonable and Allowable Amount (subject to reference pricing). BIN#: 003858 PCN: A4 Group: PH6W Toledo Hospital OP Pharmacy 419-291- 5418; Flower Hospital OP Pharmacy 419-824-1644; ProMedica Home Infusion 419-291-8247;Center for. Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. Online Read. Member ID should start with a V and 12 numeric. Step 1 Enter BIN: 003858 Step 2 Person Code: 01 Step 3 Enter PCN: A4 Step 4 Enter Rx Group: VAPC3RX Step 5 Enter 9 digit member ID: Patient SSN Step 6 Enter member's date of birth (CCYYMMDD format) If the Veteran does not have eligibility and prescription is related to an urgent care visit. Welcome to Express Scripts! We’re the manager of your PICA prescription benefit for New York City Office Of Labor Relations Employee. 1Ø1-A1 BIN Number 004336, 610591 610084, 021007 012114, 013089 020107, 020396 M 1Ø2-A2 Version/Release Number DØ M NCPDP vD. 1Ø1-A1 BIN NUMBER 610106 M BIN for PBM Plus 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M Claim Billing, Claim Rebilling 1Ø4-A4 PROCESSOR CONTROL NUMBER PBMOCE M PCN for PBM Plus 1Ø9-A9 TRANSACTION COUNT 01 = One Occurrence M 2Ø2-B2 SERVICE PROVIDER ID QUALIFIER 01 - National Provider ID. BIN: 003858 Group: VAPC3RX PCN: A4 Person Code: 01 Social Security # Veterans DOB: For questions: Please call Express Scripts Pharmacy Helpdesk 1-800-922-1557 24 hours a day, 7 days a week. Farm Bureau Essential Rx and Select Rx PDPs (AL, TN): 610011 CTRXMEDD Leon Medical Centers Health Plans - Leon Cares HMO (certain FL counties only): 017010 CIMCARE CGLEONRX. Created Date: 10/3/2019 3:00:03 PM. 0 Patch 34 Patch Addendum New/Modified Reports Menu November 2009 3. 0 M 1Ø3-A3 Transaction Code B1=Billing M 1Ø4-A4 Processor Control Number …. BIN: 003858; PCN: A4; Rx Group Number: RICEUNI; Should you have problems with your prescription claim, please ask the pharmacist to contact the Express Scripts Help Desk at 1-800-922-1557 or contact your Benefits Team. 0 communication standards. SSA Portal Mobile App is now Available. Clinical and Prior Authorization support. Pharmacy Point of Sale v1. Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 …. Bin 003858 pcn a4. Click here for the first page (E0654 - H2235) , second page (H2237 - H3959) , third page (H3962 - H5928) and fifth page (H8634 - S9701). BIN: 610591 PCN: Rx881A Group: ADV Pharmacy claims may be submitted to CVS/Caremark via the latest NCPDP D. BIN: 003858 PCN: A4 Rx Group: WFTA For assistance with claims that have a date of fill prior to 12/01/2015, please contact Express Scripts Pharmacy Help Desk at 866. Bin: 003858 Personal Code: 01 PCN: A4 Group: CCVVAACTIVE. Plan Name/Group Name: Great West TPA BIN: 017010 PCN: 05190000 Plan Name/Group Name: BIN: PCN: 1Ø4-A4 PROCESSOR CONTROL NUMBER 05180000 05190000 M Valid PCN required. Apr 05, 2021 · RX BIN: 003858 RX PCN: A4 RXGRP: UFCWLOA. Depending on the health plan a member has with Anthem, they may need to fill maintenance drugs through home delivery or an Rx Maintenance 90 pharmacy. The Customer Service number is (855) 383-7248, press 1 for IngenioRx. 0 017076 January 1, 2019 D. Pharmacy providers should ask members for an MCO identification card to verify MCO enrollment in addition to the Medicaid card. RxBIN 003858 RxPCN A4 RxGrp APNA Issuer 9151014609 (80840) ID CWK000100002 Name JOHN Q SAMPLE RxBIN 003858 RxPCN A4 RxGrp APNA ID CWK000100002 Name JOHN Q SAMPLE …. 866-848-9870; The. BIN 003858, PCN A4, Group SANFRX ; Medicaid Managed Care BIN, PCN, and Group 1/1/2019 through 12/31/2019 (pharmacy services carved out of managed care starting …. Chiropractic Care. Rx Bin: 003858 Rx Group: CN3A PCN: A4 Medicare Advantage with Prescription Drug (MAPD) Tax ID: 06‐1537522 Rx Bin: 01337 Rx Group: CN3A PCN: 0020080229 Harvard Pilgrim Health Care PO Box 699183 Quincy, MA 02269‐9183 Tax ID: 04‐2452600 RX Bin: 003585 RX Group: 35000. You may go to our website to search for an in-network pharmacy near your. X < Z > > a m m z co co z z < z > z '0 z c CD < < < o CD CD CD CD z a X CD CD z < z co O > < cn < Z CD CD CD co CD co c < Z > Z < co • co CD < c: < z. With the MyBlue Member App, you can also find a doctor, review claims, and keep track of your prescriptions. Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. Ø 1Ø3-A3 Transaction Code B1 M Billing Transaction 1Ø4-A4 Processor Control Number M Use value as printed on ID card, as communicated by CVS Caremark® or as stated in Appendix A. Plan Type. 0 019843 January 1, 2019 D. Aug 23, 2021 · Searchable list of specialty drugs that must be filled through the Specialty Drug Home Delivery program or from approved network pharmacies (CVS, Rite-Aid, Target Pharmacies or Walmart Pharmacies). Farm Bureau Essential Rx and Select Rx PDPs (AL, TN): 610011 CTRXMEDD Leon Medical Centers Health Plans - Leon Cares HMO (certain FL counties only): …. Step 1 Enter Bin Number 003858 Step 2 Enter Processor Control A4 Step 3 Enter the Group Number: NYSIF Step 4 Enter the injured worker’s 9 digit ID# Step 5 Enter first name & last name Step 6 Enter the injured worker’s date of injury (enter in PA field in the format ccyymmdd). Bin: 003858 PCN: A4 Group: MASA. » Bin Number: 003858 » PCN: A4 » Rx Group: TJC83VA » Member ID Number: This is the same ID number found on the member's Anthem medical card, but without the "TJA" prefix. Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. All other. Health Details: PLAN BIN PCN GROUP NUMBER Amerigroup 020107 CM WKHA Apple Health Fee-For-Service (FFS) 610706 WAPROD N/A Community Health 003858 A4 CHWA Coordinated Care of Washington, Inc. See FAQ below. Group: MASA. Rx Bin: 003858 Rx PCN: MD Rx Group: 2Medica. Rx BIN #:003858 Rx Group# CHPHCRE Rx PCN# A4 Help Desk 1-800-922-1557 DENTAL BENEFIT DENTEGRA Member Services Phone: 1-877-745-9687 Website: www. Chiropractic Care. ** IMPORTANT TRICARE UPDATE: Tricare Bin# 003858 / PCN# SC must be set to a "Plan Scenario" of 3 under "D. RxBIN 003858 RxPCN A4 RxGrp APNA Issuer 9151014609 (80840) ID CWK000100002 Name JOHN Q SAMPLE RxBIN 003858 RxPCN A4 RxGrp APNA ID CWK000100002 Name JOHN Q SAMPLE Here are your new PICA ID cards. BIN: 003858 PCN: A4 Rx Group: WFTA For assistance with claims that have a date of fill prior to 12/01/2015, please contact Express Scripts Pharmacy Help Desk at …. Merger Notice. Welcome to Express Scripts! We’re the manager of your PICA prescription benefit for New York City Office Of Labor Relations Employee. BIN/PCN Table. Added prior authorization fields to the claim segment. 003858 A4 WQWA United Healthcare 1-855-873-3493 610494 4900 ACUVA Magellan Complete Care 1-800-424-4524 016523 62282 VAMLTSS Optima Family Care 1-866-244-9113 610011 OHPMCAID n/a VA Premier 1-844-838-0711 009893 ROIRX n/a BIN, PCN and pharmacy helpdesk number, should you need to. Urgent care providers, who are a part of the VA contracted network, can treat Veterans without prior authorization. BIN 003858, PCN A4, Group SANFRX Medicaid Managed Care BIN, PCN, and Group 1/1/2019 through 12/31/2019 (pharmacy services carved out of managed care starting 1/1/2020) BIN 610011, PCN IRX, Group SHNNDMEDI If you have pharmacy questions, you may email them to [email protected] Restricted Pharmacy Benefits Members and providers will enjoy numerous benefits with Aetna Better Health. Rx Bin: 003858 PCN: A4 Rx Group: EGYPTRX www. Page 4 of 5 Source: BCBSTX Medicaid Provider Manual A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Member Eligibility. Created Date: 1/10/2020 11:14:17 AM. 0 017076 January 1, 2019 D. Online Read. Submitted Group (Group) VT7A (Commercial) L4FA (HIX) BVTCOM or BVTHIX. Top News The new Mercedes-AMG GT Black Series. Medical Claims: Medica Individual and Family Business. 0 Patch 34 Patch Addendum New/Modified Reports Menu November 2009 3. Effective June 27th 2017 BIN: 003858 PCN: A4 RxGroup: BSLA Effective June 27, 2017, Blue Cross and Blue Shield of Louisiana will no longer allow the Emergency Refill Too Soon (RTS) Override for Commercial and Exchange members affected by tropical storm Cindy. To setup an appointment Click here or call: 888. com Member Customer Service: 800-706-1754 Pharmacist Use Only: 800-922-1557 Providers are reimbursed pursuant to the terms of the Plan Document up to the Reasonable and Allowable Amount (subject to reference pricing). 1Ø1-a1 bin number 610014 m 1Ø2-a2 version/release number dØ m 1Ø3-a3 transaction code b1 m 1Ø4-a4 processor control number meddprime m 1Ø9-a9 transaction count 1 m 2Ø2-b2 service provider id qualifier 01 m 2Ø1-b1 service provider id npi m 4Ø1-d1 date of service m 11Ø-ak software vendor/certification id assigned when certified by. All other …. BIN: 003858 Group: VAPC3RX PCN: A4 Person Code: 01 Social Security # Veterans DOB: Created Date: 6/6/2019 4:38:57 PM. BIN: 610591 PCN: Rx881A Group: ADV Pharmacy claims may be submitted to CVS/Caremark via the latest NCPDP D. PO Box 30757 Salt Lake City. SSA Portal Mobile App is now Available. Optum Chiropractic for Medicare Advantage PO Box 212 Minneapolis, MN 55440-0212. 18 ©2020 Aetna Inc. Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing A4 003858 Group: KJFA CDPHP (800) 345-5413 (800) 388-2994. BIN: 003858: Person Code: 01: PCN: A4: Group: VETERAN: Birth Date: Enter Veteran’s date of birth (CCYYMMDD format) Member ID: Veteran’s Social Security Number (*NOTE: If the Veteran does not have their Member ID number, please ask for their Social Security Number and call 888-901-6609 for assistance. 866-525-5827 (phone) 888-491-9742 (fax) The technical support line at SXC opened for pharmacists on December 18, 2006. We expect that some client invoice amounts may vary slightly during the late December 2020 and early January 2021 invoice dates as we cut over from SS&C to the CVSH claim and invoicing cycle. rx bin: 003858. rx pcn: a4. BIN#: 003858 PCN: A4 Group: PH6W Toledo Hospital OP Pharmacy 419-291- 5418; Flower Hospital OP Pharmacy 419-824-1644; ProMedica Home Infusion 419-291-8247;Center for. Rx Bin: 003858 Rx PCN: MD Rx Group: 2Medica. Page 4 of 5 Source: BCBSTX Medicaid Provider Manual A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Member Eligibility. BIN 003858 PCN A4 Group# WFTA. com VISION. Step 1 Enter Bin # 003858 Step 2 Enter Processor Control NCP99 Step 3 Enter Rx Group #: AV8A Step 4 Enter member ID # (9 digit Employee SSN Step 5 Enter the member’s date of birth Pharmacist note: If the claim rejects, please contact the Express Scripts Pharmacy for additional assistance in looking up the correct ID. x Navitus Bin: 610602 PCN: NVT Group: SISC. Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. Effective June 27th 2017 BIN: 003858 PCN: A4 RxGroup: BSLA Effective June 27, 2017, Blue Cross and Blue Shield of Louisiana will no longer allow the Emergency Refill Too Soon (RTS) Override for Commercial and Exchange members affected by tropical storm Cindy. Aetna Better Health of Michigan Members must have their prescriptions filled at a in network pharmacy to have their prescriptions covered at no cost to them. The two dedicated phone lines for the Georgia Medicaid FFS account at SXC are as follows: Technical Support. BIN: 003858: Person Code: 01: PCN: A4: Group: VETERAN: Birth Date: Enter Veteran’s date of birth (CCYYMMDD format) Member ID: Veteran’s Social Security Number (*NOTE: If the Veteran does not have their Member ID number, please ask for their Social Security Number and call 888-901-6609 for assistance. 003858 A4 WQWA United Healthcare 1-855-873-3493 610494 4900 ACUVA Magellan Complete Care 1-800-424-4524 016523 62282 VAMLTSS Optima Family Care 1-866-244-9113 610011 OHPMCAID n/a VA Premier 1-844-838-0711 009893 ROIRX n/a BIN, PCN and pharmacy helpdesk number, should you need to. Pcn asprod1 - dvoo. Step 1 Enter RxBIN: 003858 Step 2 Enter RxPCN: A4 Step 3 Enter RxGrp: TRRX Step 4 Enter Cardholder ID Step 5 Enter Date of Birth Step 6 Enter Prescriber's DEA Number …. Added prior authorization fields to the claim segment. Rx BIN: 003858 Rx PCN: A4 Rx GROUP: 6MEDICA For benefits, use a Balance by Medica network provider. Step 1: Enter BIN: 003858; Step 2: Person Code: 01; Step 3: Enter PCN: A4; Step 4: Enter Rx Group: VAPC3RX; Step 5: Enter 9-digit member ID: Patient SSN; Step 6: Enter Veteran’s date of birth (YYYYMMDD format) For questions, please call the Express Scripts Pharmacy Help Desk at 800-922-1557 (24/7). Number (BIN) 003858 : 610011. Pharmacy providers should ask members for an MCO identification card to verify MCO enrollment in addition to the Medicaid card. 0000103331 00000 n 0000001265 00000 n BIN Help Desk Number Legacy ADV *004336 012114 013089 1-8ØØ-364-6331 CVS Caremark® 610591 As communicated by plan or refer to ID card Aetna Better. Ø 1Ø3-A3 Transaction Code B1 M Billing Transaction 1Ø4-A4 Processor Control Number M Use value as printed on ID card, as communicated by CVS Caremark® or as stated in Appendix A. Health Details: PLAN BIN PCN GROUP NUMBER Amerigroup 020107 CM WKHA Apple Health Fee-For-Service (FFS) 610706 WAPROD N/A Community Health 003858 A4 CHWA Coordinated Care of Washington, Inc. IRX : New Member ID. Rx Bin: 003858 PCN: A4 Rx Group: EGYPTRX www. 610455 JCEMP Effective January 1, 2018, claims for these plans should be submitted using the following: RXBIN RXPCN 003858 A4 For claims processing related questions, please call the. 0 General Options" tab, as well you must turn on the "Misc Option" to send Field "505-F5" (Always Send Patient Pay Amount). Apr 05, 2021 · RX BIN: 003858 RX PCN: A4 RXGRP: UFCWLOA. 1Ø1-a1 bin number 610014 m 1Ø2-a2 version/release number dØ m 1Ø3-a3 transaction code b1 m 1Ø4-a4 processor control number meddprime m 1Ø9-a9 transaction count 1 m 2Ø2-b2 service provider id qualifier 01 m 2Ø1-b1 service provider id npi m 4Ø1-d1 date of service m 11Ø-ak software vendor/certification id assigned when certified by. Member ID should start with a V and 12 numeric. Benefits/Claims - Medica: 1-800-458-5512. Commercial and HIX : Processor Control Number (PCN) A4. Plan Type. A PPO network is available for physician and ancillary services. If you do not have your Wellfleet card, follow the instructions on the flyer here to obtain it. If you have any questions while processing the claim, please call the Express Scripts Pharmacist Help Desk at 1-800-922-1557. Specialty Pharmacy: 800. Find your plan's BINs, PCNs, and RxGroups!. The chart below is the third page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H3962 through H5928. BIN: 610053, 610575, or 003858 PCN: = A4 for BIN 003858 = SC or spaces for BIN 610053 or 610575 = SC for BIN 003858 when secondary to Med D RxGroup: …. Compounded prescriptions provided to Medicaid beneficiaries paid by MCOs using the BIN/PCN table below e. Step 1 Enter Bin # 003858 Step 2 Enter Processor Control A4 Step 3 Enter Rx Group #: JCEA Step 4 Enter member ID # (9 digit Employee SSN Step 5 Enter the member's …. Example V1111111111. This section provides instructions on the new/modified reports which can help you. 0 M 1Ø3-A3 Transaction Code B1=Billing M 1Ø4-A4 Processor Control Number …. The clinical and PA support line will. All other …. If there is a Part D BIN/PCN/Group missing that you would like us to add, please shoot us an email at [email protected] Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. com VISION. Number (BIN) 003858 : 610011. 18 ©2020 Aetna Inc. 003858 A4 WQWA United Healthcare 1-855-873-3493 610494 4900 ACUVA Magellan Complete Care 1-800-424-4524 016523 62282 VAMLTSS Optima Family Care 1-866-244-9113 610011 OHPMCAID n/a VA Premier 1-844-838-0711 009893 ROIRX n/a BIN, PCN and pharmacy helpdesk number, should you need to. Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing For eligibility information, plan policy Express Scripts (800) 824-0898 …. Pharmacy Benefit Administrator, BIN, PCN, and Group Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark 1-855‐364‐2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX 8810 If you do send this segment with. Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage. Q: Can my insurance ID card be mailed to my permanent address? A: Medical ID cards are available electronically only. Group: MASA. BIN: 610053, 610575, or 003858 PCN: = A4 for BIN 003858 = SC or spaces for BIN 610053 or 610575 = SC for BIN 003858 when secondary to Med D RxGroup: …. services for benefit information. 0 M 1Ø3-A3 Transaction Code B1=Billing M 1Ø4-A4 Processor Control Number …. IRX : New Member ID. Authorizations - Optum: 1-800-873-4575. Top News The new Mercedes-AMG GT Black Series. Commercial and HIX : Processor Control Number (PCN) A4. If you have any questions …. Notice announcing the …. Policy Number: Same as the medical BCBSMA ID number. 1Ø1-A1 BIN Number See BIN/PCN table, above M 1Ø2-A2 Version Release Number DØ=Version D. The chart below is the third page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H3962 through H5928. Optum Chiropractic for Medicare Advantage PO Box 212 Minneapolis, MN 55440-0212. 0 communication standards. Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing For eligibility information, plan policy Express Scripts (800) 824-0898 …. Q: Can my insurance ID card be mailed to my permanent address? A: Medical ID cards are available electronically only. data element to be sent with all claims for this bin#. Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 Urgent Care Copay: $50 Physical Therapy Copay: $20 HEALTH PLAN: MEDICAL RX Plan: Express Scripts RxGRP: GH3A *AdvantageCare Physicians ER copay*: $150 (see details on back). 1 First Health has about 968,000 health care providers, including 700,000 specialists and 5,900 hospitals. To setup an. BIN #: 003858 PCN #: A4 RxGrp #: Subscriber ID # or SSN Patient's Date of Birth Please enter the listed details below to process the claim. 1Ø1-A1 BIN Number See BIN/PCN table, above M 1Ø2-A2 Version Release Number DØ=Version D. Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 …. Welcome to Express Scripts! We’re the manager of your PICA prescription benefit for New York City Office Of Labor Relations Employee. Pharmacy providers should ask members for an MCO identification card to verify MCO enrollment in addition to the Medicaid card. Rx Bin: 003858 Rx Group: CN3A PCN: A4 Medicare Advantage with Prescription Drug (MAPD) Tax ID: 06‐1537522 Rx Bin: 01337 Rx Group: CN3A PCN: 0020080229 Harvard Pilgrim Health Care PO Box 699183 Quincy, MA 02269‐9183 Tax ID: 04‐2452600 RX Bin: 003585 RX Group: 35000. Restricted Pharmacy Benefits Members and providers will enjoy numerous benefits with Aetna Better Health. » Bin Number: 003858 » PCN: A4 » Rx Group: TJC83VA » Member ID Number: This is the same ID number found on the member's Anthem medical card, but without the "TJA" prefix. 0 communication standards. Refer to your sum-Group Number: Member: Dependents: SPOUSE SAMPLE 01 MED Rx BIN: Rx PCN: Rx GRP: 003858 Office Visit $20. If you require more than a 14-day supply or if the prescribed medication is not needed immediately, your community provider will send a prescription to a VA pharmacy so that. Apr 05, 2021 · RX BIN: 003858 RX PCN: A4 RXGRP: UFCWLOA. Region BIN PCN/ Group Help Desk Dept of Defense (DoD Tricare) Express Scripts National 003858 gp- ESI 866/684-4466 Destination Rx - Agelity Agelity National 010439 …. 1Ø1-A1 BIN Number 004336, 610591 610084, 021007 012114, 013089 020107, 020396 M 1Ø2-A2 Version/Release Number DØ M NCPDP vD. it Pcn asprod1. 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. BIN Number 610014 610014 003858 600428 PCN Number Per card, cannot be 0s 06330000Per card, cannot be 0s A4 Group Number CVTYWVM THPWVMC WFWA. 01/11/2021 COVID-19 Vaccine Information | St Charles County, MO - Official Website. BIN: 003858: Person Code: 01: PCN: A4: Group: VETERAN: Birth Date: Enter Veteran’s date of birth (CCYYMMDD format) Member ID: Veteran’s Social Security Number (*NOTE: If the Veteran does not have their Member ID number, please ask for their Social Security Number and call 888-901-6609 for assistance. Farm Bureau Essential Rx and Select Rx PDPs (AL, TN): 610011 CTRXMEDD Leon Medical Centers Health Plans - Leon Cares HMO (certain FL counties only): 017010 CIMCARE CGLEONRX. BIN: 610053, 610575, or 003858 PCN: = A4 for BIN 003858 = SC or spaces for BIN 610053 or 610575 = SC for BIN 003858 when secondary to Med D RxGroup: …. Step 1: Enter BIN: 003858; Step 2: Person Code: 01; Step 3: Enter PCN: A4; Step 4: Enter Rx Group: VAPC3RX; Step 5: Enter 9-digit member ID: Patient SSN; Step 6: Enter Veteran’s date of birth (YYYYMMDD format) For questions, please call the Express Scripts Pharmacy Help Desk at 800-922-1557 (24/7). Drug formulary, policy and forms. PO Box 30757 Salt Lake City. 0000004568 00000 n Welcome to Express Scripts! Use your drug discount card to save on medications for the entire family ‐ including your pets. Author: jessica. 1562 for STAR. Top News The new Mercedes-AMG GT Black Series. 866-848-9870; The. Region BIN PCN/ Group Help Desk Dept of Defense (DoD Tricare) Express Scripts National 003858 gp- ESI 866/684-4466 Destination Rx - Agelity Agelity National 010439 …. Group: MASA. Medical Claims: Medica Individual and Family Business PO Box …. 0 M 1Ø3-A3 Transaction Code B1=Billing M 1Ø4-A4 Processor Control Number PCN= A4 PCN= SC: …. Plan Name/Group Name: Great West TPA BIN: 017010 PCN: 05190000 Plan Name/Group Name: BIN: PCN: 1Ø4-A4 PROCESSOR CONTROL NUMBER 05180000 05190000 M Valid PCN required. x Navitus Bin: 610602 PCN: NVT Group: SISC. Created Date: 10/3/2019 3:00:03 PM. Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing For eligibility information, plan policy Express Scripts (800) 824-0898 …. All other. Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. 1Ø1-A1 BIN Number See BIN/PCN table, above M 1Ø2-A2 Version Release Number DØ=Version D. Pharmacy Point of Sale v1. Rx Bin: 003858 PCN: A4 Rx Group: EGYPTRX www. BIN: 610591 PCN: Rx881A Group: ADV Pharmacy claims may be submitted to CVS/Caremark via the latest NCPDP D. Top News The new Mercedes-AMG GT Black Series. 1 First Health has about 968,000 health care providers, including 700,000 specialists and 5,900 hospitals. Submitted Group (Group) VT7A (Commercial) L4FA (HIX) BVTCOM or BVTHIX. Added Bin 020123 and Helpdesk number Added PCN IRXCOMAP Added field 46Ø-ET Quantity Prescribed (Effective 09/21/2020) Moved BIN 610502 to Payer Sheet (no changes were made to current setups) 1Ø4-A4 Processor Control Number M Use value as printed on ID card, as. Download the MyBlue Member App to access your digital medical/prescription …. 0000004568 00000 n Welcome to Express Scripts! Use your drug discount card to save on medications for the entire family ‐ including your pets. Pcn asprod1 - dvoo. 18 ©2020 Aetna Inc. Pharmacy Benefit Administrator, BIN, PCN, and Group Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ …. rx pcn: a4. SSA Portal Mobile App is now Available. 0 communication standards. Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 Urgent Care Copay: $50 Physical Therapy Copay: $20 HEALTH PLAN: MEDICAL RX Plan: Express Scripts RxGRP: GH3A *AdvantageCare Physicians ER copay*: $150 (see details on back). SSA Portal Mobile App is now Available. PO Box 30757 Salt Lake City. BIN: 003858 Group: VAPC3RX PCN: A4 Person Code: 01 Social Security # Veterans DOB: For questions: Please call Express Scripts Pharmacy Helpdesk 1-800-922-1557 24 hours a day, 7 days a week. Bin: 003858 PCN: A4 Group: MASA. Commercial and HIX : Processor Control Number (PCN) A4. BIN: 610591 PCN: Rx881A Group: ADV Pharmacy claims may be submitted to CVS/Caremark via the latest NCPDP D. The most powerful AMG V8 series engine of all time, the most expressive. com Member Customer Service: 800-706-1754 Pharmacist Use Only: 800-922-1557 Providers are reimbursed pursuant to the terms of the Plan Document up to the Reasonable and Allowable Amount (subject to reference pricing). Submit member ID minus first three alpha characters. If you have any questions while processing the claim, please call the Express Scripts Pharmacist Help Desk at 1-800-922-1557. 003858 MD GH3A. Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 Urgent Care Copay: $50 Physical Therapy Copay: $20 HEALTH PLAN: MEDICAL RX Plan: Express Scripts RxGRP: GH3A *AdvantageCare Physicians ER copay*: $150 (see details on back). The chart below is the fourth page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H5928 through H8634. Member ID Format. Find your plan's BINs, PCNs, and RxGroups!. BIN: 003858; PCN: A4; Rx Group Number: RICEUNI; Should you have problems with your prescription claim, please ask the pharmacist to contact the Express Scripts Help Desk at 1-800-922-1557 or contact your Benefits Team. BIN Information BIN Number Effective as of NCPDP Version 610241 January 1, 2019 D. Drug formulary, policy and forms. Region BIN PCN/ Group Help Desk Dept of Defense (DoD Tricare) Express Scripts National 003858 gp- ESI 866/684-4466 Destination Rx - Agelity Agelity National 010439 AG 800-847-7147 Diversified Pharm Svcs (DPS) Express Scripts National 003858 gp- ESI 877/776-8735 Driscoll Children's Health Plan Express Scripts TX only 003858 gp- ESI 361/904-0955. 0 PCN List for BIN 610241 MeridianRx PCN Group ID Line of Business MRXMIMCH N/A Commercial GVHPCORX N/A Commercial THPMCD N/A Commercial. Complete Directory. BIN# PC# 005947 CLAIMCR WELLRX 011891 PSG 610527 VL n/a n/a 005780 n/a 610029 CRK 610104 5100 610560 95 610474 TOI 005285 10NN 004527 9893 ROIRX 610475 n/a 003858 A4 TRRX 002286 6000002286 011511· MoSr P021011511-MoSr 005559 n/a 009992 10NN 004781 009885 011081 011297 012502 009117 011289 10868 10NN 004626 N/A. New features for your employees and dependents. With the MyBlue Member App, you can also find a doctor, review claims, and keep track of your prescriptions. Maintenance drugs are medicines used for long-term health conditions like asthma, heartburn, high blood pressure, allergies. the BIN and PCN on their customer profile to access their benefits in 2021. 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. 1, Bin# 003858, PCN: A4. Health Details: PLAN BIN PCN GROUP NUMBER Amerigroup 020107 CM WKHA Apple Health Fee-For-Service (FFS) 610706 WAPROD N/A Community Health 003858 A4 CHWA Coordinated Care of Washington, Inc. TRICARE EXPRESS SCRIPTS 5. If there is a Part D BIN/PCN/Group missing that you would like us to add, please shoot us an email at [email protected] 2088 for CHIP or 866. 004336 MCAIDADV RX5435 Molina coordination of benefits (COB) members 013089 COMESEGADV Group per … PCN. RxBIN 003858 RxPCN A4 RxGrp APNA Issuer 9151014609 (80840) ID CWK000100002 Name JOHN Q SAMPLE RxBIN 003858 RxPCN A4 RxGrp APNA ID CWK000100002 Name JOHN Q SAMPLE Here are your new PICA ID cards. » Bin Number: 003858 » PCN: A4 » Rx Group: TJC83VA » Member ID Number: This is the same ID number found on the member's Anthem medical card, but without the "TJA" prefix. Drug formulary, policy and forms. BIN# PC# 005947 CLAIMCR WELLRX 011891 PSG 610527 VL n/a n/a 005780 n/a 610029 CRK 610104 5100 610560 95 610474 TOI 005285 10NN 004527 9893 ROIRX 610475 n/a 003858 A4 TRRX 002286 6000002286 011511· MoSr P021011511-MoSr 005559 n/a 009992 10NN 004781 009885 011081 011297 012502 009117 011289 10868 10NN 004626 N/A. Search our drug formularies, find benefit and cost information for drugs, learn about our mail service pharmacy, view prior authorization procedures for drugs and find prior authorization forms. Welcome to Express Scripts! We’re the manager of your PICA prescription benefit for New York City Office Of Labor Relations Employee. BIN #: 003858 PCN #: A4 RxGrp #: Subscriber ID # or SSN Patient's Date of Birth Please enter the listed details below to process the claim. Rx BIN: 003858 Rx PCN: A4 Rx GROUP: 6MEDICA For benefits, use a Balance by Medica network provider. Rx Bin: 003858 Rx PCN: MD Rx Group: 2Medica. All other …. Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 Urgent Care Copay: $50 Physical Therapy Copay: $20 HEALTH PLAN: MEDICAL RX Plan: Express Scripts RxGRP: GH3A *AdvantageCare Physicians ER copay*: $150 (see details on back). Rx Bin Number: 003858: Rx PCN: A4: Rx Group Number WFLEET1: Member ID Number Your member ID is on your Wellfleet ID card. A PPO network is available for physician and ancillary services. To setup an appointment Click here or call: 888. BIN: 015251(OPTUMRx) 003858 PCN: PRX2000 A4 ID: HB224289455 (can be used for all patients – one (1) meter/patient) Member’s UinCare ID Number from card RxGroup: PRX2000 WFWA Pharmacists needing assistance processing a claim for meters should contact OPTUMRx at 1. 0000103331 00000 n 0000001265 00000 n BIN Help Desk Number Legacy ADV *004336 012114 013089 1-8ØØ-364-6331 CVS Caremark® 610591 As communicated by plan or refer to ID card Aetna Better. Medicare Parts B, C and D-paid prescriptions (If available) 003858 A4 Group: PMDM PA PACE 002286 0000102286 or 0000682201 26 Enter the number of prescriptions delivered during the reporting period. Rx Bin: 003858; PCN: A4 Rx Group: RX4AERO; If you are not at the pharmacy or the steps above did not work, please call the Employee Benefits Service Center at 310-336-2400 with the following information: Your name; Badge number; Call-back number; Name and phone number of pharmacy. 610455 JCEMP Effective January 1, 2018, claims for these plans should be submitted using the following: RXBIN RXPCN 003858 A4 For claims processing related questions, please call the. BIN: 003858 PCN: A4 Group: VETERAN : Urgent Care BIN: 003858 Person Code: 01 PCN: A4 Group: VAPC3RX. To setup an. Member ID should start with a V and 12 numeric. Step 1 Enter RxBIN: 003858 Step 2 Enter RxPCN: A4 Step 3 Enter RxGrp: TRRX Step 4 Enter Cardholder ID Step 5 Enter Date of Birth Step 6 Enter Prescriber's DEA Number …. The following Medical Assistance (MA) Bulletin applies to 340B covered entities that bill the MA Fee-for-Service (FFS) program and/or a MA Program managed care organization (MCO) for drugs purchased under the 340B Drug Pricing Program and dispensed to MA program beneficiaries: MAB 99-13-08: 340B Drug Pricing Program Provider Requirements and. Restricted Pharmacy Benefits Members and providers will enjoy numerous benefits with Aetna Better Health. 1Ø1-A1 BIN Number ØØ3858 M 1Ø2-A2 Version Release Number DØ=Version D. Region BIN PCN/ Group Help Desk Dept of Defense (DoD Tricare) Express Scripts National 003858 gp- ESI 866/684-4466 Destination Rx - Agelity Agelity National 010439 AG 800-847-7147 Diversified Pharm Svcs (DPS) Express Scripts National 003858 gp- ESI 877/776-8735 Driscoll Children's Health Plan Express Scripts TX only 003858 gp- ESI 361/904-0955. Rx BIN: 003858 Rx PCN: A4 Rx GROUP: 6MEDICA For benefits, use a Balance by Medica network provider. services for benefit information. A PPO network is available for physician and ancillary services. Step 1 Enter Bin Number 003858 Step 2 Enter Processor Control A4 Step 3 Enter the Group Number: NYSIF Step 4 Enter the injured worker’s 9 digit ID# Step 5 Enter first name & last name Step 6 Enter the injured worker’s date of injury (enter in PA field in the format ccyymmdd). SSA Portal Mobile App is now Available. 0 General Options" tab, as well you must turn on the "Misc Option" to send Field "505-F5" (Always Send Patient Pay Amount). BIN: 015251(OPTUMRx) 003858 PCN: PRX2000 A4 ID: HB224289455 (can be used for all patients - one (1) meter/patient) Member's UinCare ID Number from card RxGroup: …. Drug formulary, policy and forms. Added Bin 020123 and Helpdesk number Added PCN IRXCOMAP Added field 46Ø-ET Quantity Prescribed (Effective 09/21/2020) Moved BIN 610502 to Payer Sheet (no changes were made to current setups) 1Ø4-A4 Processor Control Number M Use value as printed on ID card, as. Pharmacy providers should ask members for an MCO identification card to verify MCO enrollment in addition to the Medicaid card. The following Medical Assistance (MA) Bulletin applies to 340B covered entities that bill the MA Fee-for-Service (FFS) program and/or a MA Program managed care organization (MCO) for drugs purchased under the 340B Drug Pricing Program and dispensed to MA program beneficiaries: MAB 99-13-08: 340B Drug Pricing Program Provider Requirements and. Restricted. BIN 003858 PCN A4 Group# WFTA. Pharmacy Point of Sale v1. Plan Type. 1Ø1-A1 BIN NUMBER Multiple M BIN’s listed in General Information Section 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1 M 1Ø4-A4 PROCESSOR CONTROL NUMBER Multiple M PCN’s listed in General Information Section 1Ø9-A9 TRANSACTION COUNT Ø1-Ø4 M Up to 4 transactions per B1 transmissions accepted. Urgent care providers, who are a part of the VA contracted network, can treat Veterans without prior authorization. Search our drug formularies, find benefit and cost information for drugs, learn about our mail service pharmacy, view prior authorization procedures for drugs and find prior authorization forms. BIN# 003858 | PCN# A4 | Group# F2TA. BIN: 001553PCN: GAM. Aug 23, 2021 · Searchable list of specialty drugs that must be filled through the Specialty Drug Home Delivery program or from approved network pharmacies (CVS, Rite-Aid, Target Pharmacies or Walmart Pharmacies). Policy Number: Same as the medical BCBSMA ID number. 0 PCN List for BIN 610241 MeridianRx PCN Group ID Line of Business MRXMIMCH N/A Commercial GVHPCORX N/A Commercial THPMCD N/A Commercial. the BIN/PCN table below d. Uptodate whatpercent27s new. With the MyBlue Member App, you can also find a doctor, review claims, and keep track of your prescriptions. BIN #: 003858 PCN #: A4 RxGrp #: Subscriber ID # or SSN Patient's Date of Birth Please enter the listed details below to process the claim. data element to be sent with all claims for this bin#. Chiropractic Care. BIN: 015251(OPTUMRx) 003858 PCN: PRX2000 A4 ID: HB224289455 (can be used for all patients – one (1) meter/patient) Member’s UinCare ID Number from card RxGroup: PRX2000 WFWA Pharmacists needing assistance processing a claim for meters should contact OPTUMRx at 1. If you require more than a 14-day supply or if the prescribed medication is not needed immediately, your community provider will send a prescription to a VA pharmacy so that. 18 ©2020 Aetna Inc. rx pcn: a4. Farm Bureau Essential Rx and Select Rx PDPs (AL, TN): 610011 CTRXMEDD Leon Medical Centers Health Plans - Leon Cares HMO (certain FL counties only): …. Rx Bin: 003858 Rx PCN: MD Rx Group: 2Medica. See FAQ below. X < Z > > a m m z co co z z < z > z '0 z c CD < < < o CD CD CD CD z a X CD CD z < z co O > < cn < Z CD CD CD co CD co c < Z > Z < co • co CD < c: < z. We expect that some client invoice amounts may vary slightly during the late December 2020 and early January 2021 invoice dates as we cut over from SS&C to the CVSH claim and invoicing cycle. The chart below is the fourth page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H5928 through H8634. RxBIN 003858 RxPCN A4 RxGrp APNA Issuer 9151014609 (80840) ID CWK000100002 Name JOHN Q SAMPLE RxBIN 003858 RxPCN A4 RxGrp APNA ID CWK000100002 Name JOHN Q SAMPLE …. 1Ø1-A1 BIN Number ØØ3858 M 1Ø2-A2 Version Release Number DØ=Version D. BIN: 001553PCN: GAM. Added prior authorization fields to the claim segment. Policy Number: Same as the medical BCBSMA ID number. You may go to our website to search for an in-network pharmacy near your. Rx Bin: 003858 Rx PCN: MD Rx Group: 2Medica. Created Date: 1/10/2020 11:14:17 AM. 0 New/Modified Reports Menu. 1562 for STAR. X < Z > > a m m z co co z z < z > z '0 z c CD < < < o CD CD CD CD z a X CD CD z < z co O > < cn < Z CD CD CD co CD co c < Z > Z < co • co CD < c: < z. 1, Bin# 003858, PCN: A4. 1259-re 1f21 ic(or01) or01-96000281-mc58-2-- m(o01t)d()v() 20160525b03 sh: 0 bin 2 ja1e env [1,522] csets 1 of 1. BIN: 004336: 003858: Person Code: N/A: 01: PCN: ADV: A4: Group: RX3841: VETERAN: Birth Date: N/A: Enter Veteran's date of birth (CCYYMMDD format) Member ID: …. Refer to your sum-Group Number: Member: Dependents: SPOUSE SAMPLE 01 MED Rx BIN: Rx PCN: Rx GRP: 003858 Office Visit $20. Also, reversal parameters under the "Claim" segment must be turned on to send "Other Coverage Code". BIN/PCN Table. We expect that some client invoice amounts may vary slightly during the late December 2020 and early January 2021 invoice dates as we cut over from SS&C to the CVSH claim and invoicing cycle. The chart below is the fourth page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H5928 through H8634. Health Details: PLAN BIN PCN GROUP NUMBER Amerigroup 020107 CM WKHA Apple Health Fee-For-Service (FFS) 610706 WAPROD N/A Community Health 003858 A4 CHWA Coordinated Care of Washington, Inc. com VISION. 0 communication standards. 0 018280 January 1, 2019 D. A PPO network is available for physician and ancillary services. BIN: 003858 PCN: A4 Rx Group: WFTA For assistance with claims that have a date of fill prior to 12/01/2015, please contact Express Scripts Pharmacy Help Desk at 866. PCN: NVT BIN: 610602 Medicare Part D (CompanionCare) plan members contact Navitus Customer Care. Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing A4 003858 Group: KJFA CDPHP (800) 345-5413 (800) 388-2994. SSA Portal Mobile App is now Available. Pharmacy Benefit Administrator, BIN, PCN, and Group Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX 8810. 0000103331 00000 n 0000001265 00000 n BIN Help Desk Number Legacy ADV *004336 012114 013089 1-8ØØ-364-6331 CVS Caremark® 610591 As communicated by plan or refer to ID card Aetna Better. Authorizations - Optum: 1-800-873-4575. Region BIN PCN/ Group Help Desk Dept of Defense (DoD Tricare) Express Scripts National 003858 gp- ESI 866/684-4466 Destination Rx - Agelity Agelity National 010439 …. Rx Bin: 003858 PCN: A4 Rx Group: EGYPTRX www. 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). PO Box 30757 Salt Lake City. Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds. BIN: 004336: 003858: Person Code: N/A: 01: PCN: ADV: A4: Group: RX3841: VETERAN: Birth Date: N/A: Enter Veteran's date of birth (CCYYMMDD format) Member ID: …. The chart below is the third page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H3962 through H5928. com Member Customer Service: 800-706-1754 Pharmacist Use Only: 800-922-1557 Providers are reimbursed pursuant to the terms of the Plan Document up to the Reasonable and Allowable Amount (subject to reference pricing). IRX : New Member ID. Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 Urgent Care Copay: $50 Physical Therapy Copay: $20 HEALTH PLAN: MEDICAL RxGRP: GH3A *AdvantageCare Physicians ER copay*: $150 (see details on back). The following Medical Assistance (MA) Bulletin applies to 340B covered entities that bill the MA Fee-for-Service (FFS) program and/or a MA Program managed care organization (MCO) for drugs purchased under the 340B Drug Pricing Program and dispensed to MA program beneficiaries: MAB 99-13-08: 340B Drug Pricing Program Provider Requirements and. PLAN BIN PCN GROUP NUMBER Amerigroup 020107 CM WKHA Apple Health Fee-For-Service (FFS) 610706 WAPROD N/A Community Health 003858 A4 CHWA Coordinated Care of Washington, Inc. Example V1111111111. 0 017076 January 1, 2019 D. Bin: 003858 Personal Code: 01 PCN: A4 Group: CCVVAACTIVE. 610455 JCEMP Effective January 1, 2018, claims for these plans should be submitted using the following: RXBIN RXPCN 003858 A4 For claims processing related questions, please call the. BIN: 015251(OPTUMRx) 003858 PCN: PRX2000 A4 ID: HB224289455 (can be used for all patients – one (1) meter/patient) Member’s UinCare ID Number from card RxGroup: PRX2000 WFWA Pharmacists needing assistance processing a claim for meters should contact OPTUMRx at 1. Pcn asprod1 - dvoo. Rx Bin: 003858 Rx PCN: MD Rx Group: 2Medica. 18 ©2020 Aetna Inc. Step 1 Enter BIN: 003858 Step 2 Person Code: 01 Step 3 Enter PCN: A4 Step 4 Enter Rx Group: VAPC3RX Step 5 Enter 9 digit member ID: Patient SSN Step 6 Enter member's date of birth (CCYYMMDD format) If the Veteran does not have eligibility and prescription is related to an urgent care visit. With the MyBlue Member App, you can also find a doctor, review claims, and keep track of your prescriptions. Region BIN PCN/ Group Help Desk Dept of Defense (DoD Tricare) Express Scripts National 003858 gp- ESI 866/684-4466 Destination Rx - Agelity Agelity National 010439 AG 800-847-7147 Diversified Pharm Svcs (DPS) Express Scripts National 003858 gp- ESI 877/776-8735 Driscoll Children's Health Plan Express Scripts TX only 003858 gp- ESI 361/904-0955. BIN: 610591 PCN: Rx881A Group: ADV Pharmacy claims may be submitted to CVS/Caremark via the latest NCPDP D. BIN: 001553 PCN: GAM The two dedicated phone lines for the Georgia Medicaid FFS account at SXC are as follows: Technical Support Clinical and Prior Authorization support 866-525-5826 866-525-5827 (phone) 888-491-9742 (fax) The technical support line at SXC opened for pharmacists on December 18, 2006. rx pcn: a4. Pharmacy providers should ask members for an MCO identification card to verify MCO enrollment in addition to the Medicaid card. 866-525-5826. Aetna Better Health of Michigan Members must have their prescriptions filled at a in network pharmacy to have their prescriptions covered at no cost to them. Health Details: PLAN BIN PCN GROUP NUMBER Amerigroup 020107 CM WKHA Apple Health Fee-For-Service (FFS) 610706 WAPROD N/A Community Health 003858 A4 CHWA Coordinated Care of Washington, Inc. 0 018280 January 1, 2019 D. Region BIN PCN/ Group Help Desk Dept of Defense (DoD Tricare) Express Scripts National 003858 gp- ESI 866/684-4466 Destination Rx - Agelity Agelity National 010439 …. Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds. The chart below is the third page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H3962 through H5928. Supplemental Benefits. 01/11/2021 COVID-19 Vaccine Information | St Charles County, MO - Official Website. 1259-re 1f21 ic(or01) or01-96000281-mc58-2-- m(o01t)d()v() 20160525b03 sh: 0 bin 2 ja1e env [1,522] csets 1 of 1. The two dedicated phone lines for the Georgia Medicaid FFS account at SXC are as follows: Technical Support. Medical Claims: Medica Individual and Family Business PO Box …. Rx Bin: 003858 PCN: A4 Rx Group: EGYPTRX www. Drug formulary, policy and forms. Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 Urgent Care Copay: $50 Physical Therapy Copay: $20 HEALTH PLAN: MEDICAL RX Plan: Express Scripts RxGRP: GH3A *AdvantageCare Physicians ER copay*: $150 (see details on back). BIN#: 003858 PCN: A4 Group: PH6W Toledo Hospital OP Pharmacy 419-291-5418; Flower Hospital OP Pharmacy 419-824-1644; ProMedica Home Infusion 419-291-8247;Center for Health Services OP Pharmacy 419-291-8530; The Toledo Clinic OP Pharmacy 419-479-5800; CuraScript, Inc. TRICARE EXPRESS SCRIPTS 5. Clinical and Prior Authorization support. This means community providers must enter into a contract with one of VA's Third Party Administrators (TPA). Rx BIN#: 003858 Rx PCN: A4 Underwritten by GHI PCP $0 SPEC $0 Other Providers Copay: PCP $15 SPEC $30 Lab/Radiology Copay: $20 MRI/CT Hi-Tech Radiology: $50 Urgent Care Copay: $50 Physical Therapy Copay: $20 HEALTH PLAN: MEDICAL RX Plan: Express Scripts RxGRP: GH3A *AdvantageCare Physicians ER copay*: $150 (see details on back). Apr 05, 2021 · RX BIN: 003858 RX PCN: A4 RXGRP: UFCWLOA. 18 ©2020 Aetna Inc. BIN: 003858 Group: VAPC3RX PCN: A4 Person Code: 01 Social Security # Veterans DOB: Created Date: 6/6/2019 4:38:57 PM. Edit 2: Quick Google search shows the BIN/PCN/GRP as 003858/A4/TRRX. PLAN BIN PCN GROUP NUMBER Amerigroup 020107 CM WKHA Apple Health Fee-For-Service (FFS) 610706 WAPROD N/A Community Health 003858 A4 CHWA Coordinated Care of Washington, Inc. Step 1 Enter Bin Number 003858 Step 2 Enter Processor Control A4 Step 3 Enter the Group Number: NYSIF Step 4 Enter the injured worker’s 9 digit ID# Step 5 Enter first name & last name Step 6 Enter the injured worker’s date of injury (enter in PA field in the format ccyymmdd). Rx Bin: 003858 PCN: A4 Rx Group: EGYPTRX www. Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing For eligibility information, plan policy Express Scripts (800) 824-0898 A4 003858 Group: KJBA New York Presbyterian System SelectHealth (866) 469-7774 CVS Caremark (800) 364--6331 ADV 004336 Group: RX8579. 1Ø1-A1 BIN NUMBER Multiple M BIN’s listed in General Information Section 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1 M 1Ø4-A4 PROCESSOR CONTROL NUMBER Multiple M PCN’s listed in General Information Section 1Ø9-A9 TRANSACTION COUNT Ø1-Ø4 M Up to 4 transactions per B1 transmissions accepted. 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). SSA Portal Mobile App is now Available. Bin: 003858. BIN Number 610014 610014 003858 600428 PCN Number Per card, cannot be 0s 06330000Per card, cannot be 0s A4 Group Number CVTYWVM THPWVMC WFWA. 1Ø1-a1 bin number 610014 m 1Ø2-a2 version/release number dØ m 1Ø3-a3 transaction code b1 m 1Ø4-a4 processor control number meddprime m 1Ø9-a9 transaction count 1 m 2Ø2-b2 service provider id qualifier 01 m 2Ø1-b1 service provider id npi m 4Ø1-d1 date of service m 11Ø-ak software vendor/certification id assigned when certified by. Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds. rx group: rxs4cis m d rx. Depending on the health plan a member has with Anthem, they may need to fill maintenance drugs through home delivery or an Rx Maintenance 90 pharmacy. 1Ø1-a1 bin number 610014 m 1Ø2-a2 version/release number dØ m 1Ø3-a3 transaction code b1 m 1Ø4-a4 processor control number meddprime m 1Ø9-a9 transaction count 1 m 2Ø2-b2 service provider id qualifier 01 m 2Ø1-b1 service provider id npi m 4Ø1-d1 date of service m 11Ø-ak software vendor/certification id assigned when certified by. Benefits/Claims – Medica: 1-800-458-5512. With the MyBlue Member App, you can also find a doctor, review claims, and keep track of your prescriptions. Aug 23, 2021 · Searchable list of specialty drugs that must be filled through the Specialty Drug Home Delivery program or from approved network pharmacies (CVS, Rite-Aid, Target Pharmacies or Walmart Pharmacies). Download the MyBlue Member App to access your digital medical/prescription …. 0 General Options" tab, as well you must turn on the "Misc Option" to send Field "505-F5" (Always Send Patient Pay Amount). Policy Number: Same as the medical BCBSMA ID number. Provider Training Texas’Please refer to BlueCross Shield of website at:. Step 1 Enter BIN: 003858 Step 2 Person Code: 01 Step 3 Enter PCN: A4 Step 4 Enter Rx Group: VAPC3RX Step 5 Enter 9 digit member ID: Patient SSN Step 6 Enter member's date of birth (CCYYMMDD format) If the Veteran does not have eligibility and prescription is related to an urgent care visit. Number (PCN) Bin Number Additional Information Required for Pharmacy Claim Processing A4 003858 Group: KJFA CDPHP (800) 345-5413 (800) 388-2994. Welcome to Express Scripts! We’re the manager of your PICA prescription benefit for New York City Office Of Labor Relations Employee. 0 017076 January 1, 2019 D. You may go to our website to search for an in-network pharmacy near your. 0 018280 January 1, 2019 D. Notice announcing the …. 0000004568 00000 n Welcome to Express Scripts! Use your drug discount card to save on medications for the entire family ‐ including your pets. BIN: 004336: 003858: Person Code: N/A: 01: PCN: ADV: A4: Group: RX3841: VETERAN: Birth Date: N/A: Enter Veteran’s date of birth (CCYYMMDD format) Member ID: 10-digit Member ID* number on Veteran’s VA or Department of Defense ID card OR 17-digit internal control number (ICN) Veteran’s Social Security Number. December 31, 2017, for the following BIN and PCN combination: Plan name BIN PCN Johnson Controls Inc. Commercial and HIX : Processor Control Number (PCN) A4. Ø 1Ø3-A3 Transaction Code B1 M Billing Transaction 1Ø4-A4 Processor Control Number M Use value as printed on ID card, as communicated by CVS Caremark® or as stated in Appendix A. Step 1 Enter Bin Number 003858 Step 2 Enter Processor Control A4 Step 3 Enter the Group Number: NYSIF Step 4 Enter the injured worker’s 9 digit ID# Step 5 Enter first name & last name Step 6 Enter the injured worker’s date of injury (enter in PA field in the format ccyymmdd). Optum Chiropractic for Medicare Advantage PO Box 212 Minneapolis, MN 55440-0212. BIN: 004336: 003858: Person Code: N/A: 01: PCN: ADV: A4: Group: RX3841: VETERAN: Birth Date: N/A: Enter Veteran’s date of birth (CCYYMMDD format) Member ID: 10-digit Member ID* number on Veteran’s VA or Department of Defense ID card OR 17-digit internal control number (ICN) Veteran’s Social Security Number. BIN: 610591 PCN: Rx881A Group: ADV Pharmacy claims may be submitted to CVS/Caremark via the latest NCPDP D. BIN#: 003858 PCN: A4 Group: PH6W Toledo Hospital OP Pharmacy 419-291- 5418; Flower Hospital OP Pharmacy 419-824-1644; ProMedica Home Infusion 419-291-8247;Center for. Compounded prescriptions provided to Medicaid beneficiaries paid by MCOs using the BIN/PCN table below e. Merger Notice. X < Z > > a m m z co co z z < z > z '0 z c CD < < < o CD CD CD CD z a X CD CD z < z co O > < cn < Z CD CD CD co CD co c < Z > Z < co • co CD < c: < z. Once a community provider is part of VA's contracted network, they can begin providing urgent care services to Veterans. 866-848-9870; The. BIN #: 003858 PCN #: A4 RxGrp #: Subscriber ID # or SSN Patient's Date of Birth Please enter the listed details below to process the claim. BIN: 003858 Group: VAPC3RX PCN: A4 Person Code: 01 Social Security # Veterans DOB: Created Date: 6/6/2019 4:38:57 PM. Region BIN PCN/ Group Help Desk Dept of Defense (DoD Tricare) Express Scripts National 003858 gp- ESI 866/684-4466 Destination Rx - Agelity Agelity National 010439 …. The chart below is the third page of the 2021 Medicare Part D pharmacy BIN and PCN list covering prescription drug plans from contracts H3962 through H5928. 1562 for STAR. Added prior authorization fields to the claim segment. 1259-re 1f21 ic(or01) or01-96000281-mc58-2-- m(o01t)d()v() 20160525b03 sh: 0 bin 2 ja1e env [1,522] csets 1 of 1. Bin: 003858 PCN: A4 Group: MASA. Veterans Crisis Line: 1-800-273-8255 (Press 1) Social Media. Member Services: 800-711-0917 County of Dekalb * Effective 1/1/2019 * Pharmacist. Pharmacy Benefit Administrator, BIN, PCN, and Group Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ …. PO Box 30757 Salt Lake City. Rx Bin: 003858 PCN: A4 Rx Group: EGYPTRX www. 0 019843 January 1, 2019 D. 1Ø1-A1 BIN Number See BIN/PCN table, above M 1Ø2-A2 Version Release Number DØ=Version D. Chiropractic Care. If you require more than a 14-day supply or if the prescribed medication is not needed immediately, your community provider will send a prescription to a VA pharmacy so that. Submit member ID minus first three alpha characters. You may go to our website to search for an in-network pharmacy near your. 1Ø1-A1 BIN Number ØØ3858 M 1Ø2-A2 Version Release Number DØ=Version D. BIN: 003858.