Use one of the following to request this service: MDHHS is partnering Aetna Better Health in the We Treat HEP C Initiative. hbbd```b``Sd5d`YML^?'l0yH2>HW4$21@ y0 endstream endobj startxref Provide free aids and services to people with disabilities with communicate with us, such as: Qualified sign language interpreters Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. The Pharmacy should indicate level of service 3 (emergency) on the claim. 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. 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. has adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013, designed to facilitate enrollment in Medicaid and CHIP.. 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 . 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. Michigan Medicaid number where you can call and speak to Michigan state health care agent regarding Medicaid Application Michigan is 1-888-367-6557. Tools are available in alternate formats. View 2023 Enrollment Information. 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 . 1st Medical Network - Atlanta GA. Pharmacy Billing Information. You are leaving our website and going to a non Medicare-Medicaid Plan website. They must include any medical records needed for the request. 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 . 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% The UPHP wants to help keep you and your family healthy. 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. Limitations, co-payments, and restrictions may apply. When the member receives the form, the member fills it out and mails CVS Caremark the prescription and the order form. The Michigan Medicaid office is an important government facility. What is the co-pay for MAVYRET under this agreement? Page Last Updated: 06/11/2019 Aetna Better Health of Michigans pharmacy prior authorization (PA) process is designed to approve drugs that are medically needed. Medicaid Health Plan BIN PCN Group Aetna Better Health of Michigan 610591 ADV RX8826 Blue Cross Complete of Michigan 600428 06210000 n/a . For brand name drug requests, a completed FDA MedWatch form documenting failure or issues with the generic equal is required. Reasons to choose Priority Health. [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&| 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. GROUP: RX8826. 128 0 obj <> endobj 13162. 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. CVS Caremark will mail a mail service order form. Baltimore, Maryland 21244-1850. 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. 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. Is MAVYRET covered for patients on Emergency Services Only (ESO) Medicaid? Aetna Better Health of Michigan offers mail order prescription services through CVS Caremark. G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648 wwx$AZS@NJ7B>a '2"adi=#IP$he[@HH*[sM'#(@7%}1JJI#Sdi9q m~@tR8r!#d'$G!rS`.&#Tv5mu1@[AwasrWLeRK6Z6ev &oVV[]yQ5JGqj,&}6"aewDt*&I=g{`NMh3_:%8[7u{89t,3krmrr+ Contact UPHP by emailing the Customer Service Department or by calling 1-800-835-2556. The QLLs are based on the MDHSS PDL and Common Formulary. Contact information For more information or assistance regarding Care Management, please contact Customer Service at 888.975.8102. <> 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 . That makes it easy on our members too. Forms should be mailed to: Which type of provider may prescribe Mavyret? The Pharmacy Prior Authorization form is available on our website. The Medical Director may need additional information before making a decision. This includes a wide range of benefits, such as transportation services, a 24-hour nurse help line, vision, hearing and dental coverage. Members may go to an in-network pharmacy and receive up to 8 self-test kits per month. You are now leaving Aetna Better Health of Michigans website. Network pharmacies have also been made aware of the changes to the PA status of Mavyret and should be prepared to dispense accordingly. You may go to our website to search for an in-network pharmacy near your zip code. R\J=lSkSeD!LOx[{Xp7M?tOF~~x,O:JX t 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 . RxBIN: 003858 RxPCN: MA RxGRP: HAPMCD. Ohio BWC. Your doctor will complete this form. Learn More. We provide members with the care they need, when they need it. This is especially true if you choose to apply for benefits in person at an acceptance facility. HAP Choice West Michigan HMO Option 1 HAP Choice West Michigan HMO Option 1. By Payer Id, every provider and insurance company or payer systems connect electronically with each other. Hep C treatment is carved out to MDHHS fee for service (MagellanRx) and as 4/1/2021 the system is set up to approve Mavyret for up to a 12 week supply. 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. PCN: ADV. 3 0 obj Medicaid.gov Mailbox: Medicaid.gov@cms.hhs.gov. <> 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 . Aetna Better Health also covers diabetic supplies. 24/7 access to eligibility, benefits, authorizations and more. Can patients fill their MAVYRET prescription at any Specialty or Retail Pharmacy? We take care of it all, including medical, dental, vision and mental health benefits. Aetna Better Health of MI members may use the following information along with the ID number to process prescriptions at network pharmacies: BIN: 610591. These drugs are covered by MDHSS Fee-or-service (FFS) using the Magellan Pharmacy Benefit Manager. Need help with your login or our website? endobj Toll-Free: 877-267-2323. Pharmacy providers may go to CVS/Caremark for payer sheets and additional network or processing information. 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. Visit the State of Michigan website for more information on CSHCS and eligibility. Providers Providers homepage Coronavirus (COVID-19) Prescription drug coverage determination. HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. Commercial and Medicaid BIN: 610494 PCN: 9999 COMMUNITY HEALTH BIN 610613 PCN: 2417 Maryland Medicaid BIN: 610084 PCN RXSOLPRD ProAct BIN 017366 PCN: 9999 . The preferred pen needles are BD. 1-888-417-3479 Y:1~eXXXw1Cf~2 7j; 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. G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648 If you want to receive Medicaid benefits in Michigan, you will likely need to report to one of these offices. Non-preferred DAAs will require a PA explaining why MAVYRET is not clinically appropriate: MIRx_PAfaxform_General.pdf (magellanrx.com). For questions about ID cards, benefits, claims or other issues: Call the number on the back of your member ID card or 313-225-9000. 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 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. 1199 National Benefit Fund. %PDF-1.7 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*). 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. Updates to the PDL/Common Formulary can be found online using the formulary documents linked below: MDHSS carves out specific classes of drugs. xnFaTPQsE`$.kCZYvTV/3IiD-"ssvt\{ztZ'nol>^~<9ag#s/qf-GbT%H g+b3cOo>Flov%#v? 6Q~otUs9("+r_iJ s-l["XP (QSwRWPN4Z1& &>Soy^LEOX1aL5`h!&9{Q]N0p For more information on which test kits are covered, please clickhere. Your doctor will have to complete this form. The preferred Glucose meters and Test Strips are J&J One Touch products. r-zr;5usj^7hUdCtt~qNepP}SUi?|=HHFJ{ak]6jF f/Tu:oA\6ybwYXTY6RHFcbBk[L!bp Whacv1*68$J~4?XXWkl&xP*Ue-tDQrXta@[ These counts do not include the Consumer Assessment of Healthcare . 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. 4 0 obj However, many pharmacies may default to dispensing in 4-week increments, unless the script specifies an 8- or 12-week supply. Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. A formulary is a list of drugs that Aetna Better Health covers and the formulary consists of the MDHSS PDL and Common Formulary. As an Aetna Better Health of Michigan member, you have the right to certain prescription drug benefits. Payer Id. endobj hb``e``jd```, CVS Specialty Pharmacy will assist you in filling your specialty drug. ), will they be able to complete their course of therapy (i.e., refills)? 11-A1 BIN NUMBER (see above) M 12-A2 VERSION/RELEASE NUMBER D M 13-A3 TRANSACTION CODE B1, B3 M 14-A4 PROCESSOR . 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. Insurance Name. Will there be specific PA criteria listed in the PDL for the non-preferred DAAs? MAVYRET is covered for beneficiaries on Emergency Service (ESO) Medicaid. UPHP Advantage (HMO-POS)& UPHP Choice (HMO), UPHP Prior Authorization and Notification Requirements, Espaol | | | Assyrian | Ting Vit | Shqip | | | Polski | Deutsch | Italiano | | | Srpsko-hrvatski | Tagalog. Call 1-800-905-8671 TTY 711, or use your preferred relay service for more information. 31147. 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. 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. For information regarding CSHCS Care Management, please call 616.464.8221 or email cshcs@priorityhealth.com. The Pharmacy Prior Authorization form is available on our website. 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 . Are prisoners covered by Medicaid upon release and therefore able to get MAVYRET without a PA? Learn more about PriorityMedicare D-SNP SM. H+XRWKdR0"}XJS:i1fUnv~Fy&Uw'* They must include any medical records needed for the request. 1 0 obj 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. Here is the NCPDP version D.0 Payer Sheetwith complete claims processing requirements/information for HAP Empowered Medicaid. 0FY( Our portals will be unavailable during this period. If a drug is not listed on the formulary, a Pharmacy Prior Authorization Request form must be completed. }}Ic-vPJv5 159 0 obj <>stream 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. If you receive both Medicare and Michigan Medicaid, we can coordinate your care and help you get healthier. If a drug is not listed on the formulary, a Pharmacy Prior Authorization Request form must be completed. For confirmation of carved out agents use the FFS drug search tool. For Medicaid, co-pay for MAVYRET is $1, and co-pay for non-preferred DAAs are $3. For patients currently taking another Direct-Acting Antiviral (DAA) therapy (Zepatier, Epclusa, etc. When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium. 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 By requesting your doctor to write a prescription for a 90-day supply with up to one year of refills. We help Medicaid members get the health care they need in 32 Michigan counties across the state. The preferred pen needles are BD. 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. What is the co-pay for a non-preferred DAA? A Specialty pharmacy fills drugs but has other services to help you. Xfe ZfI9Ne)[mJK\6ggSm6B'+^&bc, l~;vD>lLIBE?v~s+ Aetna Better Health of Michigan covers prescription drugs and certain over the counter drugs when presented with a prescription at a pharmacy. This information is not a complete description of benefits. They must show why a formulary drug will not work for you. 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. Get the latest information about COVID-19, the vaccine and PHE wind down. Medicaid Online To view the website for Michigan Medicaid online, click here. Members Members homepage Find a drug Request for redetermination. #current year# Health Alliance Plan of Michigan. Copyright document.write(new Date().getFullYear()) Aetna Better Health of Michigan, All Rights Reserved. This information may include the following: Both parties will be told of the decision through the telephone or mail. The preferred Glucose meters and Test Strips are J&J One Touch products. 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. p#*_.Iu/37Z* f(Yvz((j Prescription drugsare often an important part of your health care. 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 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.
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