Professionals

Reimbursement for Vaccines and Vaccine Administration Under Medicare Part D

clewis — Mon, 07 Jan 2008 08:56:43 -0600

Vaccine Administration under the Part D Program starting January 1 st , 2008. The Tax Relief and Health Care Act (TRHCA) of 2006 modified the definition of a Part D drug to include “for [Part D] vaccines administered on or after January 1, 2008, its administration .” Consequently, beginning on January 1, 2008, the Part D program will cover vaccine administration costs associated with Part D vaccines. Thus, the reimbursement currently available in 2007 under Part B will cease and reimbursement will be available solely under Part D.

Exceptions and Appeals How To

jwilliams — Mon, 26 Nov 2007 15:20:28 -0600

Q. My Medicare prescription drug plan does not cover all of my medications. What can I do to avoid paying full retail price for a prescription?

Step 1: Exceptions Process

The National Asian Pacific Center on Aging (NAPCA)

clewis — Sat, 13 Oct 2007 20:05:46 -0500

Has a National Toll-free Multilingual Helpline Center to assist API elders get direct bilingual enrollment assistance and access to translated information about the new Medicare Prescription Drug Benefit. When API seniors call this helpline, the can get language specific forms that help them determine their eligibility. They can even get help from NAPCA staff with completting the forms over the phone. Forms can also be downloaded directly from the NAPCA's Web site.

Point-of-Sale Facilitated Enrollment of Dual Beneficiaries - 12 Step Process

clewis — Tue, 09 Oct 2007 15:58:10 -0500

Quick Answers to FAQs on Processing Claims for Dual Eligible Beneficiaries

clewis — Tue, 09 Oct 2007 15:47:09 -0500

• What if a dual eligible beneficiary (Medicare and Medicaid) presents at the pharmacy and does not know what plan into which he or she has been auto enrolled?

A Model of an Explanation of Benefits

clewis — Fri, 05 Oct 2007 15:38:05 -0500

Instructions:

Plans do not need to adhere to the format of this model document. Plans may utilize their own format as long as the EOB contains all model language exactly as provided below.
Notes to plans in the squiggle brackets must not be included in the document.
Plans that offer an enhanced alternative plan must include all the bracketed notes to members discussing non-Medicare Part D drugs.

Part D Model Explanation of Benefits (EOB)

Explanation of Benefits (EOB)

clewis — Fri, 05 Oct 2007 15:35:21 -0500

A Part D Plan must send an Explanation of Benefits (EOB) to Plan enrollees during months in which enrollees utilize their prescription drug benefits. The EOB must:

List the item(s) or service(s) for which payment was made and the amount of the payment for each item or service.
Include a notice of the enrollee's right to request an itemized statement, appeal/grievance rights, and exceptions process.
Include the cumulative, year-to-date total amount of benefits provided, in relation to:
a. The deductible for the current year.
read more

Medicare Prescription Drug Benefit Brochure

clewis — Fri, 05 Oct 2007 15:06:11 -0500

Exceptions and Appeals How To

clewis — Fri, 05 Oct 2007 14:53:48 -0500

Q. My Medicare prescription drug plan does not cover all of my medications. What can I do to avoid paying full retail price for a prescription?

Step 1: Exceptions Process

CMS Part D Complaint Intake Form

clewis — Fri, 05 Oct 2007 13:35:30 -0500

CMS Part D Complaint Intake Form
FAX: 816-426-7604
CMS Kansas City Regional Office Part D Assistance Center reporting process for that has been set up to report any problems or complaints in regard to Part D.