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Important MississippiCAN, CHIP billing changes for pharmacy providers

BIN/PCN changes for MississippiCAN and CHIP plans effective October 1, 2018
The Mississippi Division of Medicaid (DOM) has required the MississippiCAN Coordinated Care Organizations (CCOs) to obtain unique Bank Identification (BIN), now known as Issuer Identification Number (IIN), and Processor Control Number (PCN) combinations. The purpose of this requirement is to enable pharmacy providers to identify and separate Pharmacy Benefit Manager (PBM) lines of business in their front-end claims processing systems.

In addition, the CCOs were required to obtain unique Network Reimbursement ID numbers for each of their Medicaid lines of business. The purpose of this requirement is to ensure that the PBM’s paid claims will not be intermingled on the same remittance advice statements. The National Council for Prescription Drug Programs (NCPDP) field associated with the Network Reimbursement ID is 545-2F. DOM will require this Network Reimbursement ID to be returned on the D.0 claim response as well as the ASCX12 835 electronic pharmacy remittances.

Both of these requirements will allow proper and adequate audit and claims processing oversight for DOM.

There will be no changes in the billing process for fee-for-service beneficiaries.

Providers should prepare their software billing systems to use the following BIN/PCN numbers for claims with dates of service of Oct. 1, 2018, and forward as follows:

Magnolia Health MSCAN (RxAdvance):

Bin PCN RXGROUP Network Reimbursement ID
020545 RXA371 RXGMSSTD RXA371

 

Magnolia CHIP (RxAdvance):

Bin PCN RXGROUP Network Reimbursement ID
020545 RXA372 RXGMSCHIP RXA372

 

Magnolia Health Plan
RxAdvance will be administering Magnolia Health’s pharmacy benefit program. Effective, Oct. 1, 2018, pharmacies are to submit pharmacy claims for payment under these programs through RxAdvance’s system.

 

Molina Health Plan (CVS Caremark):

Bin PCN RXGROUP Network Reimbursement ID
004336 MCAIDMS RX3436 MCAIDMS

 

UnitedHealthcare MSCAN (OptumRx):

Bin PCN RXGROUP Network Reimbursement ID
610494 4646 ACUMS AMCMS4 (retail), SPPMS (specialty)

 

UnitedHealthcare CHIP (OptumRx):

Bin PCN RXGROUP Network Reimbursement ID
610494 4747 ACUMS OMSCH1, OMSCH2, or OMSCH3 (retail), SPMSCH (specialty)