Updated Sept. 28, 2022
Conduent pharmacy point-of-sale claims system to shut down on Thursday, Sept. 29, 2022
The Mississippi Division of Medicaid (DOM) is in the process of implementing a new Fiscal Agent system, which will take effect at the beginning of October. This will result in a transition from Conduent to the new Fiscal Agent, Gainwell Technologies.
WHAT YOU NEED TO KNOW:
Fiscal Agent to transition from Conduent to Gainwell on Oct. 1, 2022, following pharmacy point-of-sale claims system 33-hour downtime (black-out) period
- The Conduent pharmacy point-of-sale claims system will be permanently shut down at 9 p.m. CST on Thursday, Sept. 29, 2022. The Gainwell point-of-sale system will go live at 6:00 a.m. CST on Saturday, Oct. 1, 2022. During the 33-hour transition period from the Conduent system to the new Gainwell system, pharmacy providers will be unable to submit NCPDP D.0 pharmacy claims for Medicaid fee for service beneficiaries. If providers submit claims during this downtime, they will receive NCPDP Reject 92-System Unavailable.
- The Change Healthcare Pharmacy Prior Authorization (PA) Unit will cease operations on Sept. 29, 2022, at 6 p.m. CST.
- This downtime will only impact beneficiaries with fee for service coverage. MississippiCAN/MSCHIP beneficiaries will not be affected.
- Pharmacy providers may submit Medicaid fee for service claims to Gainwell beginning at 6 a.m. CST on Saturday, Oct. 1, 2022, by using a BIN# of 025151 and a PCN of DRMSPROD.
- The Gainwell system will be unavailable for pharmacy claims submission beginning at 10 p.m. CST on Saturday, Oct. 1, 2022, through 7:59 a.m. CST on Sunday, Oct. 2, 2022. Claims may be submitted beginning at 8 a.m. on Sunday, Oct. 2, 2022, and thereafter.
WHAT YOU NEED TO DO:
- Prior to Sept. 30: Please urge your patients to refill their maintenance prescriptions. DOM will enact the “State of Emergency” provision for claims with dates of service Sept. 26 through Sept. 30 so that pharmacy providers can bypass the “2 Brand/6 Prescription” monthly limit and the “Early Refill” edits. This will be important for nursing homes performing cycle billing and filling weekend pass meds as well as for specialty pharmacies which have medications scheduled for shipment on Friday, Sept. 30. To bypass these edits, pharmacy providers can simply enter a value of “13-Payor Recognized Emergency” in NCPDP Field “420-DK.”
- Prior to Sept. 30: Please ensure you have access to the secure side of the Envision Web Portal in order to be able to check eligibility.
- Instructions for performing an Eligibility Inquiry can be found beginning on page 24 at:
- During the 33-hour black-out period: If Medicaid fee for service beneficiaries require new/urgent prescriptions, providers can check beneficiary eligibility via the Envision Web Portal up until 11:59 p.m. CST on Friday, Sept. 30, 2022.
- Pharmacy providers may call this toll-free number for assistance during the 33-hour black-out period: 1-833-660-2402.
- DOM strongly encourages pharmacy providers to fill those prescriptions for eligible fee for service Medicaid beneficiaries that may be requested during the 33-hour black-out period and bill those claims on Oct. 1, 2022 (or thereafter as long as claims are billed within timely filing parameters).
- The Change Healthcare web portal and fax number will not be available for PA submission on Friday, Sept. 30, 2022.
- Pharmacists should only dispense a 72-hour supply of drugs which require prior authorization.
To reiterate, if the provider ascertains the beneficiary does have full pharmacy benefits, the provider may fill the prescription and submit the claim to Gainwell on Oct. 1, 2022, or thereafter with the claim’s dates of service dispensed on Sept. 29 and 30.
Providers may check Medicaid eligibility using the Envision Web Portal as described above. Beneficiary eligibility spans last through the last day of the calendar month. If beneficiaries have paid claims during the month of September, the provider can be assured they have coverage on Sept. 30.
In addition to assuming fiscal agent responsibilities, Gainwell will also be responsible for all pharmacy fee for service prior authorization requests beginning Oct. 1, 2022.
- Please be aware: Medicaid beneficiaries are being alerted that they will not be able to fill prescriptions on Friday, Sept. 30, 2022. If they anticipate requiring refills during the last week of September, they are being encouraged to refill them before Friday, Sept. 30, 2022. This information will be shared via multiple channels, including DOM’s website at https://medicaid.ms.gov/.
– Published Sept. 15, 2022/Updated Sept. 28, 2022