BT200936 (TR785) - Minimum Data Set Audit Frequency Changes

INDIANA HEALTH COVERAGE PROGRAMS PROVIDER BULLETIN BT200937 NOVEMBER 17, 2009 To: Prescribing Providers and Pharmacy Providers Subject: Pharmacy Benefit Consolidation Effective January 1, 2010 Overview As advised in Indiana Health Coverage Programs (IHCP) provider bulletin BT200929, dated August 26, 2009, the Office of Medicaid Policy and Planning (OMPP) will assume responsibility for the administration of the Hoosier Healthwise (HHW) managed care organizations (MCOs) and Healthy Indiana Plan (HIP) pharmacy benefits for claims with dates of service of January 1, 2010, or later. In BT200929, this change was referred to as “carve out,” but for this and future publications, the change will be referred to as “pharmacy benefit consolidation.” This change includes processing all outpatient pharmacy claims and managing pharmaceutical services for drugs and some drug-related medical supplies and medical devices (identified in Table 1) provided by enrolled IHCP pharmacy or durable medical equipment providers as fee-for-service (FFS). As a result of this change, HP Enterprise Services will process HHW pharmacy claims currently processed by Anthem, MDwise, or Managed Health Services (MHS) and HIP pharmacy claims currently processed by Anthem Blue Cross/Blue Shield or MDwise. The FFS pharmaceutical benefit is comprehensive, and is defined by the State Plan and approved by the Centers for Medicare & Medicaid Services (CMS). Members will utilize the Indiana ...