CHIP

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Updated March 20, 2012

Texas Medicaid/CHIP Electronic Coordination of Benefits Information for Aetna Better Health and CHRISTUS Health Plan has been updated. Please see the charts below. The information provided will assist you with accurately submitting Coordination of Benefits for Texas Medicaid/CHIP members. If you receive the following or similar reject: REJECT 41 <> •

Ask member if they have other prescription coverage

•

Use the information provided in the charts below to submit the claim to the MCO

•

The OPAP field (Other Payer Amount Paid) should be populated

•

Use Other Coverage Codes 02, 03, 04

Remember, Medicaid is a “payer of last resort”, which means other forms of insurance coverage (e.g., Medicare Part B or Part D, commercial insurance, etc.) should be submitted before state of Texas Star program and CHIP Also, please update the member profile with COB information.

Aetna Better Heath Scenario Scenario #1 Scenario #2 Scenario #3

If the Primary is… Texas Medicaid/CHIP Medicare Part D Plan Commercial Insurance Plan

If the Secondary is… N/A Texas Medicaid/CHIP Texas Medicaid/CHIP

RXBIN

RXPCN

610591

ADV

610591

ADV

610591

ADV

RXBIN

RXPCN

004336

ADV

012114

COBSEGADV

013089

AMGSEGADV

RXGRP

RX8801

Amerigroup Scenario Scenario #1 Scenario #2 Scenario #3

If the Primary is… Texas Medicaid/CHIP Medicare Part D Plan Commercial Insurance Plan

If the Secondary is… N/A Texas Medicaid/CHIP Texas Medicaid/CHIP

RXGRP

RX4289

This communication and any attachments may contain confidential information. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution, or copying of it or its contents, is prohibited. If you have received this communication in error, please notify the sender immediately by telephone and destroy all copies of this communication and any attachments. This communication is a Caremark Document within the meaning of the Provider Manual. Page 1 of 2

Updated March 20, 2012

CHRISTUS Health Plan Scenario Scenario #1 Scenario #2 Scenario #3

If the Primary is… Texas Medicaid/CHIP Medicare Part D Plan Commercial Insurance Plan

If the Secondary is… N/A Texas Medicaid/CHIP Texas Medicaid/CHIP

RXBIN

RXPCN

610591

ADV

610591

ADV

610591

ADV

RXBIN

RXPCN

004336

ADV

012114

COBSEGADV

013089

COMSEGADV

RXGRP

RX8802

Molina Healthcare Scenario Scenario #1 Scenario #2 Scenario #3

If the Primary is… Texas Medicaid/CHIP Medicare Part D Plan Commercial Insurance Plan

If the Secondary is… N/A Texas Medicaid/CHIP Texas Medicaid/CHIP

RXGRP

RX0824 RX0825 RX0826

If you need a payer sheet, please visit the Caremark web-site at www.caremark.com > For Pharmacists and Medical Professionals (lower left) > Downloadable Forms and Guides > NCPDP Version D.0 Payer Sheet. If you have any questions, please call the Pharmacy Help Desk at 1-877-874-3317.

This communication and any attachments may contain confidential information. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution, or copying of it or its contents, is prohibited. If you have received this communication in error, please notify the sender immediately by telephone and destroy all copies of this communication and any attachments. This communication is a Caremark Document within the meaning of the Provider Manual. Page 2 of 2