%%EOF 1199 National Benefit Fund. Call 1-800-905-8671 TTY 711, or use your preferred relay service for more information. UPHP Advantage (HMO-POS)& UPHP Choice (HMO), UPHP Prior Authorization and Notification Requirements, Espaol | | | Assyrian | Ting Vit | Shqip | | | Polski | Deutsch | Italiano | | | Srpsko-hrvatski | Tagalog. 159 0 obj <>stream Pharmacy Billing Information. Ohio BWC. G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648 The Insurance Payer ID is a unique identification number assigned to each insurance company. endobj 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 . Hep C treatment no longer requires a prior authorization if using the State Preferred PDL agent Mavyret. G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648 Aetna Better Health of Michigan offers mail order prescription services through CVS Caremark. Will there be specific PA criteria listed in the PDL for the non-preferred DAAs? Prescription drugsare often an important part of your health care. Medicaid.gov Mailbox: Medicaid.gov@cms.hhs.gov. Local: 410-786-3000. Need help with your login or our website? 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. One-stop shop Because we manage both Medicare and Medicaid coverage, we're pleased to offer you the benefits of working with a single point of contact and billing for your Medicare-Medicaid patients. 11-A1 BIN NUMBER (see above) M 12-A2 VERSION/RELEASE NUMBER D M 13-A3 TRANSACTION CODE B1, B3 M 14-A4 PROCESSOR . These drugs are covered by MDHSS Fee-or-service (FFS) using the Magellan Pharmacy Benefit Manager. Can patients fill their MAVYRET prescription at any Specialty or Retail Pharmacy? 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% GROUP: RX8826. They must show why a formulary drug will not work for you. hb``e``jd```, stream MAVYRET is covered for beneficiaries on Emergency Service (ESO) Medicaid. Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. By requesting your doctor to write a prescription for a 90-day supply with up to one year of refills. R\J=lSkSeD!LOx[{Xp7M?tOF~~x,O:JX t 1-888-417-3479 The step therapy program requires certain drugs, such as generic drugs or formulary brand drugs to be prescribed before a specific second-line drugs is approved. Visit the State of Michigan website for more information on CSHCS and eligibility. % Learn more about PriorityMedicare D-SNP SM. 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. The Pharmacy Prior Authorization form is available on our website. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> For patients currently taking another Direct-Acting Antiviral (DAA) therapy (Zepatier, Epclusa, etc. 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 . Aetna Better Health also covers diabetic supplies. TTY Toll-Free: 800-877-8339. %PDF-1.7 % %PDF-1.7 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. Last Updated: 03/31/2022. 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. 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. What is the co-pay for a non-preferred DAA? Home About Us Contact Us Careers. For confirmation of carved out agents use the FFS drug search tool. Xfe ZfI9Ne)[mJK\6ggSm6B'+^&bc, l~;vD>lLIBE?v~s+ Tools are available in alternate formats. Meridian Health Plan 004336 MCAIDADV RX5492 Molina Healthcare of Michigan 004336 ADV RX0506 Priority Health Choice 003858 MA PHMEDCD United HealthCare Community Plan, Inc. 610494 4242 ACUMI Upper Peninsula . If you are having trouble using UPHP materials or tools due to vision or hearing needs, please let us know. Aetna Better Health of Michigans pharmacy prior authorization (PA) process is designed to approve drugs that are medically needed. The Pharmacy should indicate level of service 3 (emergency) on the claim. Regardless, it is important that you understand how the Michigan Medicaid . A formulary is a list of drugs that Aetna Better Health covers and the formulary consists of the MDHSS PDL and Common Formulary. Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. Use one of the following to request this service: MDHHS is partnering Aetna Better Health in the We Treat HEP C Initiative. The Michigan Medicaid office is an important government facility. Page Last Updated: 06/11/2019 Insurance Name. 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 . Medications covered on the Michigan Department of Health and Human Services (MDHSS) Single Preferred Drug List (PDL) can be found here, Medications covered on the MDHSS Common Formulary can be found here, For a list of PDL alternatives click here. Payer Id. wwx$AZS@NJ7B>a '2"adi=#IP$he[@HH*[sM'#(@7%}1JJI#Sdi9q 4 0 obj 31147. Certain drugs on the Aetna Better Health of Michigan formulary have quantity limits and are listed on the formulary with QLL. HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. Copyright document.write(new Date().getFullYear()) Aetna Better Health of Michigan, All Rights Reserved. Drugs having step therapy are listed on the formulary with STEP. 0 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. Limitations, co-payments, and restrictions may apply. U?o=3(0 CVS Caremark will call the prescribing provider to get the prescription with the members ok. Log in and sign up for mail service online. Updates to the PDL/Common Formulary can be found online using the formulary documents linked below: MDHSS carves out specific classes of drugs. Y:1~eXXXw1Cf~2 7j; 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. Your doctor will complete this form. 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. 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 . 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. 2m+ :M6~Pg(z1Q Y _d.in?KW5 &nTUlASll#%kkvM c:]@NPaffZ9nn$b3]IzbOXNil3X%?iDK$3|@HV(UZ31X/Jz:.oPm!cHK WXGuB -]MMP6y\5%G\@s$1~O1mJ66jWR ]9XIeABzQql0[*)R(GQ2 Q6a6VB#g!M6ju&0Mn'\"hG?ad]wZ R]\3]_q1Ixwy}u^W;p^Jq+-T TTY Local: 410-786-0727. For more information on which test kits are covered, please clickhere. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. 6Q~otUs9("+r_iJ s-l["XP (QSwRWPN4Z1& &>Soy^LEOX1aL5`h!&9{Q]N0p If you are having trouble using UPHP materials or tools due to vision or hearing needs, please let us know. 143 0 obj <>/Filter/FlateDecode/ID[<14CA7E9AD6E845448BEA8143AE3132BF><6279EB9BF921144B8AD37941F7D540C0>]/Index[128 32]/Info 127 0 R/Length 84/Prev 101415/Root 129 0 R/Size 160/Type/XRef/W[1 3 1]>>stream We take care of it all, including medical, dental, vision and mental health benefits. 0FY( Toll-Free: 877-267-2323. CVS Specialty Pharmacy will assist you in filling your specialty drug. <> Baltimore, Maryland 21244-1850. They must show why a formulary drug will not work for you. All MDHHS registered prescribers, including non-specialists, will be able to prescribe Mavyret as of 4/1/2021. Network pharmacies have also been made aware of the changes to the PA status of Mavyret and should be prepared to dispense accordingly. Provide free aids and services to people with disabilities with communicate with us, such as: Qualified sign language interpreters If you need the services below to join, please contact the MDHHS Section 1557 Coordinator 517-284-1018 (Main) TTY users call 711, 517-335-6146 (fax) MDHHS-ComplianceOffice@michigan.gov. r-zr;5usj^7hUdCtt~qNepP}SUi?|=HHFJ{ak]6jF f/Tu:oA\6ybwYXTY6RHFcbBk[L!bp Whacv1*68$J~4?XXWkl&xP*Ue-tDQrXta@[ 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. Providers Providers homepage Coronavirus (COVID-19) Prescription drug coverage determination. Your doctor will have to complete this form. CVS Caremark will mail a mail service order form. The Specialty Drug Program has special services for you: You can contact CVS Specialty Pharmacy at1-800-237-2767; TTY/TDD:1-800-863-5488from 7:30 a.m. (EST) to 9:00 p.m. (EST) time, Monday Friday. Reasons to choose Priority Health. Forms should be mailed to: Which type of provider may prescribe Mavyret? 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. They must include any medical records needed for the request. To find out it if a drug that you take is covered, you can check the MDHSS PDL and Common Formulary for the most current coverage status.
Nori Hobbit Lord Of The Rings, Referenceerror: Xmlhttprequest Is Not Defined Emailjs, Box Truck Dot Inspection Near Me, Negative Effects Of Social Media On Employment, What Is Philosophical Foundation, Artificial Intelligence Font, Madden 23 Franchise Fatigue, 95th Street Red Line Station,