In January, many dual eligibles fell through the cracks and were not assigned to prescription drug plans (PDPs) when their prescription coverage switched from Medicaid to Medicare Part D.
To address this problem, the Centers for Medicare & Medicaid Services (CMS) contracted with one national PDP (Wellpoint/Anthem) to serve as a point-of-sale solution. This allowed for dual eligibles to receive their medications while straightening out their drug coverage.
In early May, Wellpoint/Anthem sent this fax to community pharmacies notifying them that some of their initial claims from January were billed to Wellpoint in error and must now be rebilled to the proper payer. NCPA has been in communication with Wellpoint and CMS to ensure that all due diligence is being exercised to avoid excessive requirements on community pharmacy.
If you received the fax communication, you must reverse all claims by May 31, 2006 to avoid having these expenses deducted from your reimbursement checks. NCPA has been assured by CMS that plans will be required to open their claims submission window to allow rebilling of all claims.