They must show why a formulary drug will not work for you. ck${uD$FY.-jilxp2S: :G@lvo:;*^r7:L'11ts*Q#M3ETX{"TK0loB_BL%Ka| xaRs)b" yb^p{oN,y a1"9auL]] NsZ5_MfvQ_s!.H83'I $WyU.Oxo.&oGXsmB ?*!>Eu+^$%Mi)+{"_t3sTXIveO|M3)9=gfop^0&k[TcZAnG% We provide members with the care they need, when they need it. By Payer Id, every provider and insurance company or payer systems connect electronically with each other. Get the latest information about COVID-19, the vaccine and PHE wind down. In the past, the Medicaid recipient identification number assigned to recipients was a 13- digit number that included as a part of the number a two-digit parish code as the first and second digits of the number, and a two-digit eligibility category code as the third and fourth digits of the number. xnFaTPQsE`$.kCZYvTV/3IiD-"ssvt\{ztZ'nol>^~<9ag#s/qf-GbT%H g+b3cOo>Flov%#v? This information may include the following: Both parties will be told of the decision through the telephone or mail. 0 This includes a wide range of benefits, such as transportation services, a 24-hour nurse help line, vision, hearing and dental coverage. hbbd```b``Sd5d`YML^?'l0yH2>HW4$21@ y0 endstream endobj startxref HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. Call CVS Caremark, toll free at 1-800-552-8159/TTY 711, Monday to Friday between 8 a.m. and 8 p.m., for help to sign up for mail order service. %%EOF For more information on which test kits are covered, please clickhere. Tools are available in alternate formats. 6Q~otUs9("+r_iJ s-l["XP (QSwRWPN4Z1& &>Soy^LEOX1aL5`h!&9{Q]N0p p. These counts do not include the Consumer Assessment of Healthcare . CVS Caremark will call the prescribing provider to get the prescription with the members ok. Log in and sign up for mail service online. 13162. The Pharmacy should indicate level of service 3 (emergency) on the claim. HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. Medicaid Health Plan BIN PCN Group Aetna Better Health of Michigan 610591 ADV RX8826 Blue Cross Complete of Michigan 600428 06210000 n/a . D;wb3\\iUvYwLk*hC.D%)3g8?aVE\7/E @[axlg#tRxb#TbX ZbE9L(VC_GGSQ6RtC;%/1x [s,I#@`BN M9*lrt5/EY8&dxj ]|x(-Vj2dRil?hh\yLW R:9~K[eB`B\u( :|$SWf What is the co-pay for a non-preferred DAA? TTY Local: 410-786-0727. Will there be specific PA criteria listed in the PDL for the non-preferred DAAs? 11-A1 BIN NUMBER 009737 M Michigan Department of Community Health 12-A2 VERSION/RELEASE NUMBER D M 13-A3 TRANSACTION CODE B1 B2 B3 E1 M B1 Billing . 7')<7hm?O-8~h*we/x_']\F_A)R6O CB{pB/-jXkthNb. We are working on a Targeted Case Management benefit that provides support and resources for individuals recently released from a correctional facility, including some degree of in-reach, but this has not yet been implemented. Michigan Medicaid number where you can call and speak to Michigan state health care agent regarding Medicaid Application Michigan is 1-888-367-6557. %PDF-1.7 As an Aetna Better Health of Michigan member, you have the right to certain prescription drug benefits. 128 0 obj <> endobj stream The UPHP wants to help keep you and your family healthy. This information is not a complete description of benefits. If the member gives an ok, CVS Caremark will call the prescribing provider to get the prescription. Are prisoners covered by Medicaid upon release and therefore able to get MAVYRET without a PA? The Pharmacy Prior Authorization form is available on our website. &fRCKJp,LY|-+$ll gr*IA4&LR#1)0G>mze3lk6t_Ks=T[||8\PUd[z70>ks{jn64`6=#nGJ6&$!'S$t6}Tk6/W[-uV_I3vCKiXqS;fC-3{K[TDV#)NeHE1 A3I'\c|M!^ hVmk9+RV-_Sr ac9n#N} UPHP Advantage (HMO-POS)& UPHP Choice (HMO), UPHP Prior Authorization and Notification Requirements, Espaol | | | Assyrian | Ting Vit | Shqip | | | Polski | Deutsch | Italiano | | | Srpsko-hrvatski | Tagalog. What has to be submitted with a MAVYRET claim now that no PA is required? r-zr;5usj^7hUdCtt~qNepP}SUi?|=HHFJ{ak]6jF f/Tu:oA\6ybwYXTY6RHFcbBk[L!bp Whacv1*68$J~4?XXWkl&xP*Ue-tDQrXta@[ HAP Choice West Michigan HMO Option 2 HAP Choice West Michigan HMO Option 2. . 32-C2 CARDHOLDER ID M Medicaid ID Number <Michigan Medicaid> 10-digit ID 31-C1 GROUP ID MIMEDICAID R 33-C3 PERSON CODE Imp Guide: Required if needed to . For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. (800) 888-9885 (TTY: 711) MondayFriday, 8 am to 8 pm. Last Updated: 03/31/2022. For information on the organizational structure of the Centers for Medicaid and CHIP Services (CMCS), please refer to our organizational page where you can get . Provide free aids and services to people with disabilities with communicate with us, such as: Qualified sign language interpreters R\J=lSkSeD!LOx[{Xp7M?tOF~~x,O:JX t The Medical Director may need additional information before making a decision. Aetna Better Health of MI members may use the following information along with the ID number to process prescriptions at network pharmacies: BIN: 610591. Prescription drugsare often an important part of your health care. Y:1~eXXXw1Cf~2 7j; p#*_.Iu/37Z* f(Yvz((j Copyright document.write(new Date().getFullYear()) Aetna Better Health of Michigan, All Rights Reserved. Call 1-800-905-8671 TTY 711, or use your preferred relay service for more information. Can more than 4 weeks of therapy be prescribed at a single time (e.g., 8 weeks of therapy, or less frequently 12 weeks of therapy, as opposed to 4 weeks with refill(s))? People 65 and older with Medicaid may also be eligible for a Dual Eligible Special Needs Plan, or D-SNP. Commercial and Medicaid BIN: 610494 PCN: 9999 Community Health BIN: 610613 PCN: 2417 ProAct BIN: 017366 PCN: 9999 FlexScripts/ProAct BIN: 018141 PCN: 9999 United Healthcare Community Plan of Indiana BIN: 610494 PCN: 4841 . Medicaid.gov Mailbox: Medicaid.gov@cms.hhs.gov. For confirmation of carved out agents use the FFS drug search tool. Healthy Michigan is a low cost program that offers health coverage to adults age 19 - 64 who do not qualify for Medicaid or Medicare and whose income is at or below 133% of the federal poverty level. Limitations, co-payments, and restrictions may apply. What is the co-pay for MAVYRET under this agreement? % Submenu for Insurance through your employer, Learn more about individual and family plans, Medicaid and MI Health Link Pharmacy Providers, Medicaid Drug Rebate Program Labeler List Reference. We will be conducting planned maintenance on our site from Friday, 10/14 at 9:30 PM until Saturday, 10/15 at 12:30 AM. Your doctor will have to complete this form. By requesting your doctor to write a prescription for a 90-day supply with up to one year of refills. <> endobj 159 0 obj <>stream The specialty drug list is availablehere. #IAY#=p^{aDLETD%uWF\,(-XJoH K@Iv ?3o3 kPtPd])*Ai#xL`NQM"3D(7;u}'S-vG4@ljx[{`##07zDHFb7WNaWy1O/D]='mRB_;9^6w1ncGfVpO# K{8I^hS;bI3 =uQgOsv?9i. The Insurance Payer ID is a unique identification number assigned to each insurance company. Medicaid Drug Rebate Program Labeler List Reference - To help you more easily identify Medicaid rebatable NDCs, we are posting a monthly reference list here. Pharmacy Billing Information. G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648 This plan is available to anyone who has both Medical Assistance from the State and Medicare. CVS Specialty Pharmacy will assist you in filling your specialty drug. Contact UPHP by emailing the Customer Service Departmentor by calling 1-800-835-2556. G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648 For more information about MDHSS Fee-for-service carve outs please click here. #current year# Health Alliance Plan of Michigan. H0192_001_WEB_1494050. They must include any medical records needed for the request. We require doctors to obtain a PA before prescribing or giving out the following: Aetna Better Health of Michigans Medical Director decides if a drug is denied or approved using MDHSS guidelines. All MDHHS registered prescribers, including non-specialists, will be able to prescribe Mavyret as of 4/1/2021. m~@tR8r!#d'$G!rS`.&#Tv5mu1@[AwasrWLeRK6Z6ev &oVV[]yQ5JGqj,&}6"aewDt*&I=g{`NMh3_:%8[7u{89t,3krmrr+ 11 -A1 BIN NUMBER (see above) M 12 -A2 VERSION/RELEASE NUMB ER D M 13 -A3 TRANSACTION CODE B1, B3 M 14 -A4 PROCESSOR CONTROL NU MBER See above M Required for All Claims . 11-A1 BIN NUMBER (see above) M 12-A2 VERSION/RELEASE NUMBER D M 13-A3 TRANSACTION CODE B1, B3 M 14-A4 PROCESSOR . We are one of the top-rated Medicaid plans in Michigan, with a rating of 4 out of 5 in NCQA's Medicaid Health Insurance Plan Ratings 2021-2022. HAP Choice West Michigan HMO Option 1 HAP Choice West Michigan HMO Option 1. %PDF-1.7 % Click herefor more information about the opioid resources provided by MDHSS including a link to a copy of a Nonopioid Directive form in your language. Pharmacy providers may go to CVS/Caremark for payer sheets and additional network or processing information. They must include any medical records needed for the request. Pharmacies are authorized to dispense up to 102 days of therapy at a single time. If you do not intend to leave our site, please click Close. If you want to receive Medicaid benefits in Michigan, you will likely need to report to one of these offices. Use one of the following to request this service: MDHHS is partnering Aetna Better Health in the We Treat HEP C Initiative. 1st Medical Network - Atlanta GA. If you have any questions about a drug that is not listed, please call Member Services toll-free at1-866-316-3784(TTY711), 24 hours a day, 7 days a week. Your doctor will complete this form. H+XRWKdR0"}XJS:i1fUnv~Fy&Uw'* endobj Can patients fill their MAVYRET prescription at any Specialty or Retail Pharmacy? You are now leaving Aetna Better Health of Michigans website. If you need the services below to join, please contact the MDHHS Section 1557 Coordinator 517-284-1018 (Main) TTY users call 711, 517-335-6146 (fax) MDHHS-ComplianceOffice@michigan.gov. A Specialty pharmacy fills drugs but has other services to help you. Contact information For more information or assistance regarding Care Management, please contact Customer Service at 888.975.8102. 24/7 access to eligibility, benefits, authorizations and more. Commercial and Medicaid BIN: 610494 PCN: 9999 COMMUNITY HEALTH BIN 610613 PCN: 2417 Maryland Medicaid BIN: 610084 PCN RXSOLPRD ProAct BIN 017366 PCN: 9999 . Members may go to an in-network pharmacy and receive up to 8 self-test kits per month. When the member receives the form, the member fills it out and mails CVS Caremark the prescription and the order form. Non-preferred DAAs will require a PA explaining why MAVYRET is not clinically appropriate: MIRx_PAfaxform_General.pdf (magellanrx.com). The Upper Peninsula Health Plan (UPHP) is a managed care organization for people covered by Michigan Medicaid, MIChild, Childrens Special Health Care Services, and the Healthy Michigan Plan. Medicaid Office Location Michigan Department Community Health 201 Townsend Street Capitol View Building Lansing, MI 48913 Medicaid Office Phone Number The phone number to call the Michigan Medicaid office is 800-642-3195 or in state call 517-373-3740. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. For Medicaid, co-pay for MAVYRET is $1, and co-pay for non-preferred DAAs are $3. [Vf,c.DwN`h`(@GBt dr x lth0t3CM!X$I,e?D Fo#aCR[v7G|Ec$Cq_ &k>L8 p){Tn$i(zD$T%BX7"z8I4}zCtT|`I&| Michigan Medicaid hours of operation regarding Medicaid Application Michigan are Monday through Friday, from 8:30 am - 4:30pm, but the best calling hours for Michigan Medicaid to call regarding . PCN: ADV. RxBIN: 003858 RxPCN: MA RxGRP: HAPMCD. You can talk to a Pharmacist 24 hours a day, seven days a week, Disease-specific education and counseling are available by CVS, Care Coordination for you and your doctor, Delivery of Specialty drugs to yourhome and/or your doctors office is available for drop off and pick up at any CVS Pharmacy location (including those inside Target stores*). The Michigan Medicaid office is an important government facility. Home About Us Contact Us Careers. Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. Xfe ZfI9Ne)[mJK\6ggSm6B'+^&bc, l~;vD>lLIBE?v~s+ AHCCCS Health Plans BIN PCN Group Number PBM Phone Number AHCCCS FFS 001553 AZM OptumRx 855-577-6310 AHCCCS FFS - Secondary to Commercial 001553 AZM OptumRx 855-577-6310 AHCCCS FFS - Dual Eligibles for Covered OTC Prescriptions 001553 AZM OptumRx 855-577-6310 United Healthcare Community Plan (Acute, CRS, DD, LTC) 610494 4100 ACUAZ OptumRx . Meridian Health Plan of Michigan, Inc. is rated 4 out of 5 in NCQA's Medicaid Health Insurance Plan Ratings 2016-2017 and NCQA's Medicaid Health Insurance Plan Ratings 2017-2018. The preferred Glucose meters and Test Strips are J&J One Touch products. Plan H9572_801 RxBIN 610014 RxGRP MEDPRIME RxGRP BCBSMAN Enrollee Name VALUED CUSTOMER XYL999999999 Enrollee ID Issuer (80840) 9101003777 XXXXX Group Number 01/2019 Issued Medicare PLUS That makes it easy on our members too. A formulary is a list of drugs that Aetna Better Health covers and the formulary consists of the MDHSS PDL and Common Formulary. 1 0 obj For brand name drug requests, a completed FDA MedWatch form documenting failure or issues with the generic equal is required. Forms should be mailed to: Which type of provider may prescribe Mavyret? Aetna Better Health of MI members may use the following information along with the ID number to process prescriptions at network pharmacies: Pharmacy providers may go toCVS/Caremarkfor payer sheets and additional network or processing information. Tools are available in alternate formats. Please see the below FAQ for further information for prescribers of Mavyret as part of the We Treat HEP C Initiative: ABH of MI covers COVID-19 self-test kits through the pharmacy benefit without a prescription. Aetna Better Health also covers diabetic supplies. Certain drugs on the Aetna Better Health of Michigan formulary have quantity limits and are listed on the formulary with QLL. endobj Aetna Better Health Specialty Drugs are filled by CVS Health Specialty Pharmacy. Learn More. Toll-Free: 877-267-2323. Aetna Better Health of Michigan will fill prescriptions for a seventy-two (72) hour supply if the member is waiting for a decision by the Plan. There are no co-pays for viral hepatitis treatments for Healthy Michigan Plan. You are leaving our website and going to a non Medicare-Medicaid Plan website. If you are having trouble using UPHP materials or tools due to vision or hearing needs, please let us know. If a drug is not listed on the formulary, a Pharmacy Prior Authorization Request form must be completed. Regardless, it is important that you understand how the Michigan Medicaid . Your doctor can request an override step therapy and/or a quantity limit by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. View 2023 Enrollment Information. 31147. Contact UPHP by emailing the Customer Service Department or by calling 1-800-835-2556. The claim will be paid if submitted in accordance with our Pharmacy Claims Processing Manual: Will MAVYRET be covered without a PA in the rare case a patient requires 12 weeks of therapy? MAVYRET is covered for beneficiaries on Emergency Service (ESO) Medicaid. https://michigan.magellanrx.com/provider/external/medicaid/mi/doc/en-, Aetna Better Health Premier Plan (Medicare-Medicaid), Children's Special Health Care Services (CSHCS), Case/Disease Management (Care Management), Non-formulary drugs that are not excluded under a States Medicaid program, Prescriptions that do not follow our guidelines (like quantity limits, age limits or step therapy), Brand name drugs, when a generic is available, Drugs on the formulary have been tried and does not work (i.e., step therapy), No other drugs on the formulary would work as well as the drug requested, The request is acceptable by the Federal Drug Administration (FDA) or is accepted by nationally noted experts. endstream endobj 129 0 obj <>/Metadata 3 0 R/Pages 126 0 R/StructTreeRoot 7 0 R/Type/Catalog/ViewerPreferences 144 0 R>> endobj 130 0 obj <>/MediaBox[0 0 792 612]/Parent 126 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 131 0 obj <>stream
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