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2017-32: Claims Processing Update for Network Pharmacies

Date: 07/28/17

Envolve Pharmacy Solutions (formerly US Script) and CVS Caremark® announce, EFFECTIVE SEPTEMBER 1, 2017, CVS Caremark will begin processing all claims for Louisiana Healthcare Connections. Claims will be reimbursed according to your CVS Caremark Network Enrollment Forms and be paid according to CVS Caremark processing rules and payment cycles.

CVS Caremark processing rules and payment cycles will appear on your CVS Caremark 835 or remittance advice. Please update or create Louisiana Healthcare Connections member profiles to reflect the claims processing charges.

  • RXBIN: 004336
  • RXPCN: MCAIDADV
  • RXGRP: RX5444
  • Member ID Format: 13 digits

IMPORTANT: When applicable, you must rely on the claims system to determine the correct amount to collect from Louisiana Healthcare Connections members.

Per federal Medicaid law, no provider participating under Healthy Louisiana may deny services to a patient because of their inability to pay the Patient Pay Amount.

NOTE: Louisiana Healthcare Connections members will begin receiving new Member ID cards with updated pharmacy information in the mail prior to Sept. 1, 2017. Members will begin using the new cards on Sept. 1, 2017. Until that date, members will continue using their current cards. Members who have not received the updated Member ID card by Sept. 1, 2017, should call Member Services at 1-866-595-8133 to request an updated card. The member Medicaid ID number will remain the same 13 digit number.

For member eligibility verification or prior authorization, call Louisiana Healthcare Connections at 1-866-595-8133. For general questions, call the Pharmacy Help Desk at 1-800-311-0543.

For additional claims processing information, refer to “NCPDP Payer Sheets” online at: www.caremark.com/pharminfo.