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March 2005 Part B Medicare Bulletin

Posted March 4, 2005

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1st Quarter Update
Part B Not Otherwise Classified Drug Fee Sched

2005 Payment Allowance Limits for Medicare Part B Not Otherwise Classified (NOC) Drugs

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2005 Drug Administration Coding Revisions - MMA

Provider Types Affected
Physicians billing Medicare carriers for drug administration.

Provider Action Needed
Physicians should note that this article is based on Change Request (CR) 3631; it clarifies the 2005 drug administration coding revisions. In the final physician fee schedule rule published in the Federal Register on November 15, 2004, the Centers for Medicare & Medicaid Services (CMS) announced that it would adopt G-codes for 2005 that correspond to the new Current Procedural Terminology (CPT) drug administration codes that will become effective in 2006.

The new G-codes will apply on an interim basis until 2006. As CMS is adopting the G-codes, CMS is also adopting, in 2005, the CPT coding rules that will not officially appear until the CPT 2006 is published.

The relevant CPT drug administration codes approved by the CPT Editorial Panel are grouped into three categories:

Note: The allowances for these codes reflect the application of the 2005 transitional payment adjustment of 3 percent, which by law is applicable only to drug administration codes.

Background
The Social Security Act (Section 1848c(2)(J), as modified by the Medicare Modernization Act (MMA) (Section 303a)), requires CMS to promptly evaluate existing drug administration codes for physicians’ services to ensure accurate reporting and billing for those services, taking into account the levels of complexity of the administration and resource consumption. The law further provides that CMS must use Disclaimer existing processes for the consideration of coding changes and, to the extent changes occur, use those processes to establish values for those services.

The American Medical Association’s (AMA’s) CPT Editorial Panel established a workgroup, with members from affected specialties, who met earlier in 2004 to develop recommendations on drug administration coding. The workgroup presented its recommendations to the CPT Editorial Panel in August, 2004. Based on those recommendations, the CPT Editorial Panel adopted several new drug administration codes and revised several existing codes.

Subsequently, the AMA’s Relative Value Update Committee (RUC) met at the end of September 2004 to make recommendations to CMS on the practice expense resource inputs and work relative values for the new and revised drug administration codes.

The 2005 CPT was already published prior to the adoption of the new and revised drug administration CPT codes. Therefore, the new and revised drug administration codes, and the CPT coding rules applicable to them, will appear in the 2006 CPT.

In the physician fee schedule final rule published in the Federal Register on November 15, 2004, CMS announced that it would adopt G-codes for 2005 that correspond to the new CPT codes that will become active in 2006. These new G codes are considered interim until 2006.

As CMS adopts the G-codes, CMS is also adopting in 2005 the CPT coding rules for the new drug administration codes in their current form that will not officially appear until the CPT 2006 is published.

Currently, Medicare allows chemotherapy administration codes to be used only for reporting chemotherapy administration when the drug being used is an anti-neoplastic and the diagnosis is cancer (see the Medicare Claims Processing Manual, Chapter 12, Section 30.5 at
http://www.cms.hhs.gov/manuals/104_claims/clm104c12.pdf.

Under the new codes, chemotherapy administration codes will apply to parenteral administration of nonradionuclide anti-neoplastic drugs and also anti-neoplastic agents provided for the treatment of noncancer diagnoses (e.g. cyclophosphamide for autoimmune conditions), or to substances such as monoclonal antibody agents and other biologic response modifiers.

At this time, CMS is not developing a national list of approved chemotherapy drugs. CMS will allow each Medicare carrier to develop such a list.

Another important change pertains to the creation of new codes to identify additional sequential infusions. Current CPT codes do not separately identify additional sequential infusions apart from additional hours of infusion. Consistent with the new codes adopted by the CPT Editorial Panel, CMS implemented new G codes to separately identify additional sequential infusions. There are also new codes to identify additional nonchemotherapy sequential intravenous pushes and intravenous chemotherapy pushes for additional drugs.

“Subsequent” drug administration codes, or codes that state the code is listed separately in addition to the code for the primary procedure, should be used to report these secondary codes.

When administering multiple infusions, injections or combinations, only one “initial” drug administration service code should be reported per patient per day, unless protocol requires that two separate IV sites must be used.

If an injection or infusion is of a subsequent or concurrent nature, even if it is the first such service within that group of services, then a subsequent or concurrent code from the appropriate section should be reported. The initial code is the code that best describes the primary service the patient is receiving and the additional codes are secondary to the primary procedure.

The new drug administration G-codes and their descriptors for 2005 are described below. The allowances for these codes reflect the application of the 2005 transitional payment adjustment of three percent, which, by law (MMA section 303(a)(4)), is applicable only to drug administration codes.

New G-Codes for Hydration Services
For services furnished prior to January 1, 2005, CPT did not include distinct codes for hydration infusion services. Infusions involving hydration or nonchemotherapy drugs were billed using CPT codes 90780 and 90781.

For services furnished in 2005, CPT codes 90780 and 90781 will not be recognized under the Medicare physician fee schedule. The following new G-codes should be used instead:

Codes G0345 and G0346 are intended to report a hydration IV infusion consisting of a prepackaged fluid and/or electrolyte solutions (e.g., normal saline, D5-1/2 normal saline +30mEq KC1/liter), but are not used to report infusion of drugs or other substances.

Hydration IV infusion typically requires direct physician supervision for purposes of consent, safety oversight, or intra-service supervision of staff. Typically such infusions require little special handling to prepare or dispose of, and staff who administer these do not typically require advanced training. After initial setup, infusion typically entails little patient risk and thus little monitoring.

Report G0346 for hydration infusions of greater than thirty minutes beyond one-hour increments, or hydration greater than thirty minutes provided as a secondary or sequential service after a different initial infusion or chemotherapy service is provided.

New G-Codes for Nonchemotherapy Therapeutic or Diagnostic Injections and IV Infusions (Other than Hydration)

IV Infusions
For services furnished in 2005, nonchemotherapy infusions for therapy or diagnosis are reported using new G-codes:

G0348 is used to report additional hour(s), beyond the first hour, of sequential infusion as well as the second and subsequent hours of the initial drug. Report G0348 for infusion intervals of greater than thirty minutes beyond one-hour increments.

Also, prior to January 1, 2005, distinct codes did not exist to report concurrent and/or sequential nonchemotherapy infusions involving a different drug. For 2005, there is new G codes that distinctly describe these services:

If a significant separately identifiable evaluation and management (E & M) service is performed, the appropriate E & M service code should be reported utilizing modifier 25 in addition to codes G0347-G0354. For an E & M service provided on the same day, a different diagnosis is not required.

If performed to facilitate a therapeutic/diagnostic infusion or injection, the following are included and are not reported separately:

Nonchemotherapy Injections
After January 1, 2005, Codes 90782 and 90784 will not be recognized under the Medicare physician fee schedule, and CPT codes 90783 and 90788 remain in effect. For 2005, 90782 is replaced by:

Code 90784 (currently used for IV push of nonchemotherapy drugs) is replaced in 2005 by the following two codes that separately identify the initial and additional nonchemotherapy IV push:

What is Intravenous/Intra-Arterial Push?
Intravenous or intra-arterial push is defined as an injection/infusion of short duration (i.e., thirty minutes or less) in which the healthcare professional who administers the substance/drug is continuously present to administer the injection and observe the patient.

For services furnished prior to 2005, codes 90782 to 90788 were only payable under the Medicare physician fee schedule if there were no other services billed on the same date by the same provider (status indicator “T”). Otherwise, these services were bundled into the other service(s) for which payment was made.

For services furnished on or after January 1, 2005, services described by codes G0351, G0353, G0354, and CPT codes 90783 and 90788, may be paid in addition to other physician fee schedule services billed by the same provider on the same day of service (the status indicator of “T” is removed and replaced with the “A” status indicator).

Note: Certain Medicare policies, including but not limited to, correct coding edits for the services described by codes G0351, G0353, G0354, and CPT codes 90783 and 90788 may apply.

Use code G0351 for non-anti-neoplastic hormonal therapy injections and use G0356 for anti-neoplastic hormonal injection therapy.

Use G0354 to report an intravenous push subsequent to another drug administration service, if appropriate.

Do not report G0345-G0354 with codes (including injections and intravenous chemotherapy, intra-arterial chemotherapy, and other chemotherapy) for which IV push or infusion is an inherent part of the primary procedure (e.g., administration of contrast material for a diagnostic imaging study).

New G-Codes for Chemotherapy Administration
For services furnished on or after January 1, 2005, chemotherapy administration codes apply to parenteral administration of nonradionuclide anti-neoplastic drugs and also to anti-neoplastic agents provided for the treatment of noncancer diagnoses (e.g., cyclophosphamide for auto-immune conditions) or to substances such as monoclonal antibody agents and other biologic response modifiers. Administration of anti-anemia drugs and anti-emetic drugs by injection or infusion for cancer patients is not considered chemotherapy administration. Such services are reported using codes from the range G0347 to G0354.

Currently, CPT has one code for subcutaneous or intramuscular chemotherapy administration, 96400. For services in 2005, there are new G-codes that uniquely describe the administration of hormonal and nonhormonal anti-neoplastics:

CPT code 96400 is not recognized under the Medicare physician fee schedule in 2005.

The following two CPT codes are still recognized for Medicare purposes in 2005:

The expanded definition of chemotherapy as described above will apply to these codes beginning January 1, 2005.

Currently, CPT has one code for chemotherapy administration with IV push technique, 96408. For

services in 2005, there are two new G-codes to report the initial push and additional pushes:

CPT code 96408 is not recognized under the Medicare physician fee schedule in 2005.

For services furnished prior to January 1, 2005, chemotherapy intravenous infusions (other than prolonged infusions, as discussed below) were billed using CPT code 96410 for the first hour and code 96412 for each additional hour. There was not a distinct code to report a sequential chemotherapy infusion involving a different drug.

For services furnished in 2005, chemotherapy intravenous infusions are reported using the following new G-codes, which include a separate code for additional drugs infused:

Beginning January 1, 2005, under the Medicare physician fee schedule, the following G code should be used instead of code 96414:

• G0361, “Chemotherapy administration, intravenous initiation of prolonged chemotherapy infusion (more than eight hours), requiring the use of a portable or implantable pump”.

Report G0360 for infusion intervals of greater than thirty minutes beyond one-hour increments.
Use G0362 in conjunction with G0359, if appropriate. Report G0362 only once per sequential infusion.

Report G0360 for additional hour(s) of sequential infusion.

If a significant separately identifiable E & M service is performed, the appropriate E & M CPT code should be reported utilizing modifier 25 in addition to codes G0355-G0363, 96405-96406, 96420-96520, 96530-96549. For an E & M service provided on the same day, a different diagnosis is not required.

If performed to facilitate the chemotherapy infusion or injection, the following are included and are not reported separately:

For declotting a catheter or port, see CPT code 36550.

Report separate codes for each parenteral method of administration employed when chemotherapy is administered by different techniques. Medications (e.g., antibiotics, steroidal agents, anti-emetics, narcotics analgesics) administered independently or sequentially as supportive management of chemotherapy administration should be separately reported using G0346, G0348, G0350, G0354, or CPT codes 90783 or 90799 as appropriate.

Report the specific service as well as code(s) for the specific substance or drug(s) provided.

Intra-Arterial Chemotherapy
CPT codes 96420, 96422, 96423, and 96425 are recognized for Medicare purposes in 2005. Report CPT code 96423 for infusion intervals of greater than thirty minutes beyond one-hour increments.

Other Chemotherapy
CPT codes 96440, 96445, 96450, and 96520 are recognized for Medicare purposes in 2005.

Medicare will pay for G0363 Irrigation of implanted venous access device for drug delivery systems if it is the only service provided that day. If there is a visit or other drug administration service provided on the same day, payment for G0363 is included in the payment for the other service.

CPT codes 96530 and 96542 are recognized for Medicare purposes in 2005.

Add-On Codes
Eight of the new drug administration G codes have the following parenthetical descriptor included as a part of the code, “List separately in addition to code for primary procedure.” These eight codes are: G0346, G0348, G0349, G0350, G0354, G0358, G0360, and G0362. Each of these codes has a status indicator of “ZZZ” meaning this service is allowed if billed with another drug administration service.

Do not interpret this parenthetical descriptor to mean that the add-on code can be billed only if it is listed with another drug administration primary code. For example, code G0346 ordinarily will be billed with code G0345. However, there may be instances where only the add-on code, G0346, is billed because an “initial” code from another section in the drug administration, instead of G0345, is billed as the primary code.

Billing of Code 99211
Continue to implement the policy in section 30.5 of chapter 12 of Pub 100-04 with respect to the billing of code 99211 with a nonchemotherapy or chemotherapy drug infusion code. Also apply this policy to 99211 when billed with a diagnostic or therapeutic injection code furnished in 2005.

Table 1: 2005 Drug Administration G Codes

Old Code New Code Descriptor Add on Code
90780 G0345 Intravenous infusion, hydration; initial, up to one hour Yes
90781 G0346 Intravenous infusion, hydration; each additional hour,
up to eight (8) hours (List separately in addition to
code for procedure)		  
90780 G0347 Intravenous infusion, for therapy/diagnosis (specify
substance or drug); initial, up to one hour		  
90781 G0348
Intravenous infusion, for therapy diagnosis (specify
substance or drug); each additional hour, up to eight
hours (List separately in addition to code for procedure) 		Yes
90781 G0349 Intravenous infusion, for therapy/diagnosis (specify
substance or drug); additional sequential infusion, up
to one hour (List separately in addition to code for procedure)		 Yes
N/A G0350 Intravenous infusion, for therapy/diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for procedure) Yes
90782 G0351 Therapeutic or diagnostic injection (specify substance or drug); subcutaneous orintramuscular  
90784 G0353 Therapeutic or diagnostic injection (specify substance or drug); intravenous push,single or initial substance/drug  

The following codes represent active CPT drug administration codes under the Medicare physician fee schedule in 2005:

Partial List of Drugs Commonly Considered to Be Monoclonal Antibodies and Hormonal Anti -
neoplastics

As noted above, chemotherapy administration codes apply to:

The following drugs are commonly considered to fall under the category of monoclonal antibodies:

Drugs commonly considered to fall under the category of hormonal anti-neoplastics include:

The drugs cited are not intended to be a complete list of drugs that may be administered using the chemotherapy administration codes. Local carriers may provide additional guidance as to which drugs may be considered to be chemotherapy drugs under Medicare.

Implementation
The implementation date for this instruction is January 17, 2005.

Additional Information
To see the official instruction issued to your carrier regarding this change, go to:
http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp

From that Web page, look for CR 3631 in the CR NUM column on the right, and click on the file for that CR. If you have any questions, please contact your carrier at their toll-free number, which may be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf

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How to Locate Specific Transmittals/Change Requests (CRs) of Interest That Are Posted on Centers for Medicare & Medicaid

Provider Types Affected
All Medicare physicians, providers, suppliers, and others who use the Medlearn Matters Articles and Related Change Request Information

Provider Action Needed
This Special Edition article has been written to assist physicians, providers, and suppliers in locating specific Change Requests of interest that CMS has issued and posted on its Web site.

Background
CMS Program Transmittals/Change Requests (CRs) are used to communicate new or changed policies, and/or procedures that are being incorporated into a specific CMS program manual, and Medlearn Matters articles are written about selected CMS Transmittals/Change Requests to assist providers in understanding these transmittals. Each Medlearn Matters article usually has a section included at the end of the article titled Additional Information that includes a variation of the following statement:

For complete details (regarding this Change Request XXXX), please see the official instruction issued to your carrier/intermediary regarding this change. That instruction may be viewed at: http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp

From that Web page, look for the CR XXXX in the CR NUM column on the right, and click on the file for that CR.

Note: The above Web site includes Transmittals/CRs issued for the current year. Therefore, starting in January 2005, the above Web site includes only those Transmittals/CRs with communication (comm.) release dates during calendar year 2005.

However, if you scroll down to the end of the above Web site page, you will find options for being redirected to Web sites for Transmittals/CRs issued in previous years (2000 through 2004).

An abbreviated copy/view of the above CMS Web site screen is shown below:

Medicare & Medicaid
2005 Program Transmittals/Program Memos
Table of Contents
SIZE FILE COMMUNICATION (COMM) DATE MANUAL SUBJECT IMPLEMENTATION DATE CR NUM
51KG R425CP 1/11/2005 PUB 100-04

Section 630 of the ...

 4/3/2005 3521
168kb R423CP 1/6/2005 PUB 100-04 January 2005 Update of the ... 1/14/2005 3632

**The files listed above are PDF (Portable Document Format) files. In the past the transmittal cover page was all we were able to put on the Internet. PDF format enables us to put the entire transmittal on the Internet. You can view and print PDF files exactly as they were originally printed in paper form. To view these documents, you must have the Adobe Acrobat Reader, which can be downloaded at no cost at: Adobe Reader - Download - http://www.adobe.com/products/acrobat/readstep2.html

2004 Transmittals | 2003 Transmittals | 2002 Transmittals | 2001 Transmittals

Accessing CRs released prior to January 1, 2005
If you want to review a Transmittal/CR with a release date in a previous year, you can select the desired year, and you will be redirected to one of the following Web sites:

• 2004 - http://www.cms.hhs.gov/manuals/pm_trans/2004/transmittals/comm_date_dsc.asp
• 2003 - http://www.cms.hhs.gov/manuals/pm_trans/2003/transmittals/comm_date_dsc.asp
• 2002 - http://www.cms.hhs.gov/manuals/pm_trans/2002/transmittals/comm_date_dsc.asp
• 2001 - http://www.cms.hhs.gov/manuals/pm_trans/2001/transmittals/comm_date_dsc.asp
• 2000 - http://www.cms.hhs.gov/manuals/pm_trans/2000/transmittals/comm_date_dsc.asp

Once you have accessed the desired Transmittal/CR Web site, you can sort the Table of Contents (example shown above) by clicking your mouse on any column heading. To reverse the order of the sort for that column, click on the sort order icon ( or ).

For some users, once you have accessed the desired Transmittal/CR Web site, type Ctrl F (i.e., hold down the Control (Ctrl) key first, then press the ‘f’ key), and a ‘Find’ box will appear. Type the desired CR number in the ‘Find What?’ box, press the enter key, and you will be taken directly to the CR of interest which will be highlighted.

Additional Information
If you have any questions, please contact your carrier/intermediary at their toll-free number, which may be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf

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MCS Crossover Process Information

CIGNA Government Services sends adjudicated Medicare claims information to secondary insurance companies for their benefit determination. This process is called Coordination of Benefits (COB) or crossover. There are three types of COB: Complementary Crossover, Medicaid Crossover and Medigap Crossover.

Reminder!

CMS has decided to streamline the claims crossover process to better serve our customers. During 2005, each COB trading partner will now enter into one national Coordination of Benefits Agreement (COBA) with the CMS’ consolidated claims crossover contractor, the Coordination of Benefits Contractor (COBC). Medigap crossover process will be changed in the future, but will be the same for 2005.

CMS will provide generic Medicare Summary Notice (MSN) and Remittance Advice (RA) messages for claims transmitted to the COBC for crossover purposes and we will keep you informed of the changes to the current process. You will continue to contact the Medicare carrier Customer Service department for your questions about an individual’s crossover status.

Please watch for future communication regarding this change.

Complementary Crossover

Complementary crossover is the transfer of adjudicated Medicare claims information based upon eligibility data supplied to CIGNA Government Services by the secondary insurance companies called Trading Partners. We have service agreements with Trading Partners for automatic crossover of the claim information. According to the agreement, companies provide us with an eligibility file on a weekly or monthly basis that lists all beneficiaries that are eligible for their insurance coverage. CIGNA Government Services’s crossover process is designed to match the Health Insurance Claim Number (HICN) on the adjudicated claims with the HICN provided on the eligibility files from the Trading Partners. CIGNA Government Services can not change, update or delete any records from the trading partner’s eligibility file according to the service agreement. All complementary claim crossover files are sent each week for both assigned and non-assigned claims. No additional information is needed on the claim for the complementary crossover process to occur.

The Medicare Remittance Notice (MRN) identifies complementary crossover claims using the following ANSI code: MA18 for claims that have been crossed to complementary insurance companies.

Some claims can be excluded from the crossover process.

  1. The Trading Partner can specify that the following claims will be excluded from the crossover process:

  1. In the MCS system, a patient’s first Medicare claim establishes the beneficiary’s claim history. Afterward, Medicare uses this history to indicate a crossover eligibility record. If a beneficiary has no Medicare history available, the insurer’s individual record for that beneficiary will remain unidentified. Until Medicare claim history is established, the identification of supplemental crossover eligibility will be unavailable. Medicare performs routine eligibility updates using each company’s most recent eligibility data. This minimizes the number of occurrences of this first claim situation. Companies send their eligibility file on a weekly or monthly basis.

Complementary Companies as of December 2004

AAG Benefits Adminsitrators Health Care Service Corporation
AARP Operations Health Scope Benefits
AEGON Highmark Life & Casualty
Aetna Healthcare GE Capitol Assurance
AFLAC GE Life ASsurance and Annuity
AFSA Gilsbar Ins
Aid Association for Lutherans Highmark Services Insurance
Alled Benefits System Humana Inc.
Alternative Professional Services Inc. ITT Hartford
Amalgamated Life Kanawha Ins. Co.
American Capitol Kenyon College Retirees
AMerican Family KPS Health Plans
American General Life Insurance CO of Georgia
American Insurance Admin Group Lincoln Heritage Life Insurance
American Legion Medicaid Crossover
American National Ins. Co. Mennonite Mutual Aid
american Republic Ins. co. MOAA
Amerihealth Monumental Life
Anthem FEP Mutual of Omaha (Group)
APWU Health Plan Mutual of Omaha (Individual)
Assoc Doctors Health and Life Mutual Protective
Atlantic American National Assoc. Of letter Carriers
*BCBS of Tennessee (Only State Employees /Retirees) NEA
Bankers Fidelity Life and Casualty New Era Life Enterprise
BC California NGS American
BC Idaho North American Health Plans
BCBS of Alabama North American Insurance
BCBS of Arkansas Olympic
BCBS of Delaware Oxford Life Insurance
BCBS of Florida PacifiCare Health Plan Admin.
BCBS of Illinois Pekin Life Insurance
BCBS of Iowa Peoples Benefit Life Ins.
BCBS of Kansas Physicians Mutual Insurance Company
BCBS of Massachusetts Pioneer
BCBS of Michigan POMCO
BCBS of Minnesota Preferred Health Systems
BCBS of Mississippi Premera Blue Cross
BCBS of New Jersey Principal Financial Group
BCBS of New Mexico Principal Life Insurance
BCBS of North Carolina Pyramid
BCBS of North Dakota Regence BS
BCBS of Oregon Regence Regence BS ID Federal Employees
BCBS of Rhode Island Regence BS Of Idaho
BCBS of Texas Regence BS WA FEP
BCBS of Utah Regence Retiree Medical Plans
BCBS of West Virginia ROA
BCBS of Wisconsin SAMBA
Benefit Planners Limited Savers Life Insurance
BeneSys Inc. State Farm Insurance Company
BS California State Mutual Insurance
C & R Consulting Stirling and Stirling
CAC /Mail Handlers Thriven Financial
Capitol Blue Cross TMG Health
Carefirst BCBS (NC claims only) TRICARE
Celtic Life Insurance Unicare
Central Benefits Life Insurance Unified Life Insurance Company
Central States Health & Life of Omaha Union Banker/PMSC
Christian Fidelity Insurance Union Fidelity
CIGNA Union Fidelity Life Insurance
Comprenhensive Benefits Untied American Ins. Co.
Continential General Insurance Co. United Commerical Travelers
Continential Life Ins. Co. United HealthCare
Coresource United Medical Resources
Country Life Insurance United Methodist Church
Empire HealthChoice Inc. United Teacher Associates Insurance Company
Epoch Group USAA Life Insurance Co.
Equitable USAble Life Insurance
Federal Home Life Insurance Wakely and Associates
FRA Wausau Company
GEHA Westport Benefits
Great West World Insurance Company
Group Health Inc. Worldnet Services Corp.

Medicaid Crossover

Medicaid crossover is the transfer of adjudicated Medicare claims information based upon eligibility data supplied to CIGNA Government Services by the State Medicaid Agency. We have a standard Trading Partner Agreement (TPA) with Medicaid agencies for automatic crossover of claim information. All Medicaid claim crossover files are sent each week, but only for assigned claims.

The Medicare Remittance Notice (MRN) identifies Medicaid crossover claims using the following ANSI code: MA07 for claims that have been crossed successfully to Medicaid. The MRN will not have the name of the Medicaid Agency.

Medicaid Agencies as of January 2005

Medicaid Idaho

Medicaid North Carolina

Medicaid Tennessee (TennCare Bureau)

Medicaid Kentucky in testing mode

Medigap Crossover

MCS will not change the Medigap crossover process, but new Other Carrier Name and Address (OCNA) will be required because MCS allows only five characters for OCNA.

Important dates! You should begin to submit the new OCNA number as indicated below:

Tennessee/Idaho transitioned to MCS on 02/01/05

1/19/2005 - All paper claims received and controlled on or after this date will be processed in the MCS system following cutover.

1/26/2005 - All EMC claims received and controlled on or after this date will be processed in the MCS system following cutover.

North Carolina transitioned to MCS on 03/01/05

2/16/2005 - All paper claims received and controlled on or after this date will be processed in the MCS system following cutover.

2/23/2005 - All EMC claims received and controlled on or after this date will be processed in the MCS system following cutover.

The term “Medigap” refers to Medicare supplemental policies that are private health insurance plans designed to supplement Medicare benefits by filling in some of the “gaps” in Medicare coverage. This type of policy typically covers the coinsurance amount (20%) that Medicare did not pay or the amount applied toward the beneficiary’s deductible. Medigap crossover is designed to lessen paperwork for the provider/supplier and beneficiary community and as an incentive for those entities who elect to be participating providers/suppliers in the Medicare program.

Medigap crossover is the transfer of adjudicated assigned claims information to the insurance companies that offer Medigap coverage. Medigap crossover only occurs based upon information submitted on the claim by the provider.

There are several criteria involved in a successful crossover of claims data to Medigap insurance companies:

o For ANSI format in 2300 loop (Claim Information) element CLM07 = A and 2320 (Other Subscriber Information) element OI04 = B

o For paper claims in Item 9A of the CMS-1500 form;

o For ANSI format in 2320 loop (Other Subscriber Information) element SBR05 = MI and 2330A loop (Other Subscriber Name) element NM108 = MI and element NM109 = Medigap policy number

o For paper in Item 9D on the CMS-1500 form;

o For ANSI format in 2330B loop (Other Payer Name) element NM103 = Payer Name, element NM108 = PI and element NM109 = OCNA

o The beneficiary may sign the CMS - 1500 claim form at item 13. The beneficiary may sign a one-time signature authorization that the provider/supplier will keep on file. If the one-time authorization is used “signature on file” may be entered in block 13 of the CMS - 1500 form.

o For ANSI format in 2300 loop (Claim Information) element CLM08 = Y and in 2320 loop (Other Subscriber Information) element OI03 = Y

Important! Please use the correct individual Medigap Policy number from the patient’s insurance card bindividual Medigap Policy number. Our system does not validate Medigap Policy numbers. We are sending the information that was received on Medigap claims.

Tip! When selecting a Medigap OCNA number, you need to match the name and the address of Medigap Company from the patient’s insurance card. If you cannot find the match, please be sure to check the list of Complementary Crossover Companies.

OCNA list as of January 2005 for Tennessee and North Carolina

Name New MCS OCNA Old VMS OCNA Address City State Zip
ACADEMY LIFE INC. CO. MG049 30328A001 UNITED TEACHER ASSOC PO BOX 26580 AUSTIN TX 787550580
ADVANCED INS SVC/BENEFIX MX036 38101A001 85 N. DANNY THOMAS BLVD MEMPHIS TN 381032398
AMER ASSOC UNIV WOMEN MX064 50398A001 1776 WEST LAKES PKWY DES MOINES IA 50398
AMER COMBINED LIFE MX006 19047A001 PO BOX 1009 LANGE-HORNES PA 190476009
AMER GEN LIFE & ACC INS MX009 19049A001 PO BOX 10845 CLEARWATER FL 337578845
AMER GENERAL GRP INS MX091 75266A001 PO BOX 660238 DALLAS TX 720660038
AMER GENERAL LIFE & ACC MX021 28816A001 PO BOX 6855 ASHEVILLE NC 288166855
AMER GENERAL LIFE & ACC MX095 77251A001 PO BOX 1931 HOUSTON TX 772511931
AMER INCOME LIFE INS MG131 76702A001 PO BOX 2608 WACO TX 767022608
AMER INS CO OF TX MX092 75266A002 PO BOX 660254 DALLAS TX 752660254
AMER TRAVELLERS INS MG0023 19020A001 PO BOX 10319 DES MOINES IA 503060319
AON SELECT,INC MG103 64111A001 406 W 34TH ST KANAS CITY MO 64111
BANKERS LIFE & CASUALTY MG098 60630B001 540 NORTH COLLEGE DR DIC CARMEL IN 460324911
BCBS OF ARIZONA MG144 85069B001 PO BOX 3700 PHOENIX AZ 850690000
BCBS OF GEORGIA MG051 31908B001 PO BOX 7368 COLUMBUS GA 31999
BCBS OF KANSAS CITY MG105 64146B001 PO BOX 419169 KANSAS CITY MO 641416169
BCBS OFLOUISIANA MG113 70898B001 PO BOX 98029 BATON ROUGE LA 708989029
BCBS OF MEMPHIS MX037 38101B001 PO BOX 98,79,10,30 MEMPHIS TN 381010097
BCBS OF MONTANA MG094 59403B001 PO BOX 5004 GREAT FALLS MT 940350045
BCBS OF NEW HAMPSHIRE MG003 03306B001 3000 GOFFS FALLS ROAD MANCHESTER NH 31110001
BCBS OF NEW YORK MG008 10036B001 320 W 46TH ST 4TH FL NEW YORK NY 100363845
BCBS OF NEW YORK MG012 13221B001 344 S WARREN ST SYRACUSE NY 132214809
BCBS OF NEW YORK MG013 13502B001 12 RHOADS DR UTICA NY 135026306
BCBS OF NEW YORK (EMPIRE) MG010 10943B001 75 CRYSTAL RUN RD MIDDLETOWN NY 109430001
BCBS OF OHIO MG064 43085B001 6740 N HIGH ST WORTHINGTON OH 430852536
BCBS OF PENNSYLVANIA MG016 17407B001 70 MAIN ST N WILKES BARRE PA 17407
BCBS OF SOUTH CAROLINA MG044 29260b001 PO BOX 6000 COLUMBIA SC 292606000
BCBS OF TENNESSEE MG061 37402B001 801 PINE ST CHATTANOOGA TN 374023958
BCBS OF VERMONT MG004 05601B001 PO BOX 186 MONTPELIER VT 56010186
BCBS OF WYOMING MG137

82003B001

 PO BOX 2266 CHEYENNE WU 833030489
BENEFIX MX039 38101B003 85 N DANNY THOMAS BLVD MEMPHIS TN 381032398
BLUE CROSS OF CONNECTICUT MG005 06473B001 PO BOX 122 NORTH HAVEN CT 06473
CAL FARM LIFE INS CO MG152 95851C001 POO BOX 15016-1016 SACREMENTO CA 958510000
CATHOLIC GOLDEN AGE INS MG019 18503C001 400 LACKAWANNA AVE SCRANTON PA 185032014
CERTIFIED LIFE INS CO MX074 60630C001 222 MECHANDISE M PLA CHICAGO IL 606540000
CERTIFIED LIFE INS CO MX090 7526C001 PO BOX 650209 DALLAS TX 752655433
CNA/CONTINENTAL CASUALTY MX024 32859C001 PO BOX 593925 ORLANDO FL 328593925
COLONIAL PEN INS CO MX012 19181C001 1818 MARKET ST 25TH FL PHILADELPHIA PA 191810000
COMBINED INS CO OF AMER MX007 19047C001 PO BOX 568 LANGHORNE PA 190470568
COMMON- WEALTH NATL LIFE IN MX041 38732C00 CENTRAL UNITED LIFE 2727 ALLEN PARKWAY HOUSTON TX 77019
COSMOPOLITAN INC CO MX106 91365c001 PO Box 4174 WOODLAND HLS CA 913654171
DALLAS GENERAL LIFE MG120 75221D001 PO BOX 1080 DALLAS TX 752219047
DIRECT RESPONSE MG089 55438D001 7930 CENTURY BLVD CHANHASSEN MN 553178000
DURHAM LIFE INS CO MG036 27627D001 PO BOX 61 DURHAM NC 277020061
EDUCATORS MUTUAL MG141 84107E001 852 ARROWHEAD LN MURRAY UT 841075211
FEDREAL HOME LIFE INS MX025 32887F001 6277 SEA HARBOR DR ORLANDO FL 32887
FORTIS FAMILY MG045 29602F001 PO BOX 19061 GREENVILLE SC 296029061
FRA MILICARE MX016 20063F001 3100 M STREET NW WASHINGTON DC 20063
GEORGIA LIFE & HEALTH INS CO MG048 30301G001 PO BOX 4884 HOUSTON TX 772104884
GOLDEN RULE INS CO MG075 46278G001 7400 WOODLAND DR INDIANAPOLIS IN 462781720
GOLDEN RULE INS CO MX076 62439G001 712 11TH ST LAWRENCEVILLE IL 641112736
GOOD SAM INS CO MG150 93121G001 PO BOX 21807 SANTA BARBARA CA 931211807
GUARANTEE RESERVE LIFE MX073 60409G001 530 RIVER OAKS W CALUMET CITY IL 604095407
GUARANTEE TRUST LIFE INS MG095 60025G001 1275 MILWAUKEE AVE GLENVIEW IL 600251500
GULF LIFE INS CO MX033 37250G001 AMERICAN GENERAL CTR NASHVILLE TN 372500001
HAWAII MEDICAL SRV ASSOC MG153 96808HOO1 PO BOX 860 HONOLULU HI 968080860
INTEGRITY NATL LIFE INS MX045 402321001 PO BOX 32350 LOUISVILLE KY 402322350
LIBERTY LIFE INS CO MG046 29602L001 COMPANION LIFE PO BOX 100133 COLUMBIA SC 292023133
LIFE INS CO OF VIRGINIA MX010 19053L001 4850 E STREET RD FSTRVL TRVOSE PA 190536646
MILICARE MX017 20063M001 2100 M STREET N.W. WASHINGTON DC 20063
MILICARE/FLEET RESERVE MX018 20063M002 3060 WILLIAMS DR ST.3 FAIRFAX VA 20063
MONUMENTAL GENERAL INS CO MG031 21201M001 111 N CHARLES ST BALTIMORE MD 212015544
NATL BENEFIT CORP MX077 61444N001 406 W 34TH ST KANSAS CITY MO 64111
NATL FINANCIAL INS CO MG126 75266N001 110 WEST 7TH ST STE 300 FORT WORTH TX 76102
NATL FOUNDATION LIFE MG128 76102N001 801 CHERRYS T UNIT 33 FORT WORTH TX 76102
ATL LIFE & ACC MX034 37250N001 M/C 1512 AMERICAN GENERAL CTR NASHVILLE TN 374022520
NATL SECURITY LIFE & ACCI MG127 76015N001 PO BOX 149151 AUSTIN TX 787149151
OLD AMER INS CO MG106 641410001 6520 BROADWAY PO BOX 418573 KANSAS CITY MO 652180001
OLD SURETY LIFE INS CO MG117 731540001 PO BOX 54407 OKLAHOMA CITY OK 731541407
PENINSULAR LIFE INS CO MG035 27605P001 1001 WADE AVE RALEIGH NC 27605
PENN TREATY LIFE INS CO MG018 18103P001 3440 LEHIGH ST ALLENTOWN PA 181037001
PEOPLES SECURITY LIFE INS MG039 27702P001 PO BOX 61 DURHAM NC 27702
PERSONAL HEALTH CARE MG032 24038P001 PO BOX 14046 ROANOKE VA 240384046
PROTECTED HOME MUT LIFE MG015 16146P001 30 E STATE ST SHARON PA 161461705
PROVIDENTIAL LIFE INS CO MG115 72203P001 PO BOX 66967 CHICAGO IL 606660967
RESERVE NATL LIFE IN MG116 73118R001 6100 NW GRAND BLVD OKLAHOMA CITY OK 731250097
SECURE HORIZONS HLTH PL MG147 90630S001 5995 PLAZA DR CYPRESS CA 906300489
SENTRY LIFE INS MG084 54481S001 1800 NORTH POINT DR STEVENSPOINT WI 54481
SHELTER LIFE INS CO MG107 65218S001 1817 W BROADWAY COLUMBIA MO 662023336
SOUTHERN HEALTH PLAN MX040 38101S001 PO BOX 97 MEMPHIS TN 381010097
TRUSTMARK INS CO MG096 60045B001 400 FIELD PO BOX 7900 LAKE FOREST IL 600450000
UNITED FAMILY LIFE INS MX023 30301U001 PO BOX 2204 ATLANTA GA 303012204
UNITED FARM BUREAU FAMILY MG073 4326U001 PO BOX 1250 INDIANAPOLIS IN 462077025
UNITED SEC ASSURANCE CO MG022 18964U001 673 E CHERRY LN SOUDERTON PA 189641236
UNIVERSAL FIDELITY LIFE MX085 73533U001 2211 N HIGHWAY 81 DUNCAN OK 735331222
VFW MEDICARE SUPPLEMENT MG104 64111V001 C/O AON SELECT INC PO BOX 961085 FORT WORTH TX 76160000
WISCONSIN PHYSICIANS SERV MX066 53701W001 1717 W BROADWAY MADISON WI 53701

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Influenza Treatment Demonstration

Provider Types Affected
Physicians, providers, and suppliers

Provider Action Needed
Physicians, providers, and suppliers should note that Medicare will cover four new flu medications, including -where applicable - their generic equivalents. These medications are Amantadine Hydrocloride; Zanamivir, Inhalation Power Administered through Inhaler; Oseltamivir Phosphate, Oral; and Rimantadine Hydrochloide, Oral.

These drugs will be paid under a Centers for Medicare & Medicaid Services (CMS) demonstration for dates of service through May 31, 2005. In addition, physicians, providers and suppliers that enroll in Medicare before May 31, 2005, may also file claims for drugs furnished under this demonstration for dates of service beginning when the provider or supplier completes such enrollment.

Background
The Centers for Disease Control and Prevention (CDC) recommends that individuals in the following groups should be vaccinated against influenza annually:

Early in the flu vaccination season it was reported that there would be a shortage of vaccine due to manufacturing problems. Although it appears that there will be ample flu vaccine, many Medicare beneficiaries may not have been vaccinated and remain at risk. Vaccination against flu is still the best protection; however, for those Medicare beneficiaries who have been unable to receive a flu vaccination, the next best approach to protect them is to provide coverage for antiviral medicines that can prevent the complications of influenza infection by reducing the duration and severity of the infection. The shorter the duration of the infection, the less time the individual is contagious to others. In some cases, the antiviral medicine can also act as a primary preventive agent.

Influenza Treatment Demonstration
CMS is undertaking a demonstration project to measure the impact of providing coverage for certain antiviral drugs to treat and/or prevent influenza.

The Influenza Treatment Demonstration will provide coverage to Medicare beneficiaries for Food and Drug Administration -approved drugs for the treatment and targeted prevention of influenza.

Specifically, under this demonstration, Medicare will cover certain anti-viral drugs when furnished:

However, the demonstration does not cover these anti-viral drugs for general prophylactic use.

The following drugs (including, when applicable, bioequivalents or generic equivalents) are included in the demonstration:

The drugs under this demonstration must be furnished incident to a physician service or must be prescribed by a physician (or other practitioner authorized by State law to prescribe such drugs).

Except as noted below, all ancillary Medicare rules apply to the furnishing of these drugs to Medicare beneficiaries under this demonstration. Also, information regarding treatment and drug dosage of these influenza antiviral medications is included in the Additional Information Section of this special edition.

The demonstration will include dates of service through May 31, 2005. Also, note that all claims for drugs furnished under this demonstration must be filed no later than December 31, 2005.

Physicians, providers, and suppliers that enroll in Medicare before May 31, 2005, may also file claims for drugs furnished under this demonstration for dates of service beginning when the provider or supplier completes such enrollment.

Payment Amounts
Both the Medicare co-payment and deductible apply to all claims under this demonstration, including claims for Medicare Advantage (MA) beneficiaries. The exception is in the calculations of co-payments for beneficiaries participating in the Drug Discount Card program. These beneficiaries will pay the lesser of 20% of the Medicare allowable amount or 20% of the negotiated Drug Discount Sponsor’s price for antiviral medicines, plus $.20 (20% of a $1.00 administrative charge). A chart explaining how to do the calculations for determining co-payment amount for Drug Discount Card participants is attached. CMS will also make this chart available on its Web site at http://www.cms.hhs.gov/researchers/demos/flu and will update cost information monthly. Finally, no deductible will apply to claims from Federally Qualified Health Centers (FQHCs).

Except as noted below, the Medicare allowed amount for these demonstration drugs will be based on 95% of the average wholesale price (AWP) for the brand name of each drug (Zanamivir and Oseltamivir Phosphate) covered under this demonstration, determined in accordance with customary Medicare payment policy. For drugs marketed as bioequivalent or generics (Amantadine and Rimantadine), the allowed amount will be based on 90% of AWP.

For the duration of the demonstration, the allowed HCPCS codes/charges are as follows:

Those entities that are to be paid on a basis other than of 90% or 95% of AWP are as follows:

Billing Instructions
Claims for drugs furnished under this demonstration may be submitted by enrolled Medicare providers as follows: hospitals including CAHs, skilled nursing facilities (SNFs), renal dialysis facilities (RDFs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Home Health Agencies (HHAs) and by enrolled physicians, other practitioners, or other suppliers that are authorized under State law to dispense these drugs.

Except as noted below, providers, physicians, and other suppliers must follow customary Medicare billing and claims processing rules.

Acceptance of assignment is mandatory for all claims submitted under this demonstration and Medicare Secondary Payer (MSP) rules apply to claims under this demonstration.

Implementation
The implementation date for this instruction is January 17, 2005.

Additional Information

Treatment and Drug Dosage of Influenza Antiviral Medications
You are referred to the Centers for Disease Control and Prevention Web site (Antiviral Agents for Influenza:

Background Information for Clinicians) at: http://www.cdc.gov/flu/professionals/antiviralback.htm

Treatment
For the treatment of influenza, controlled studies have found that neuraminidase inhibitor drugs (Zanamivir, Oseltamivir) and adamantane derivative drugs (Amantadine, Rimantadine) administered within 48 hours of illness onset, decrease viral shedding and reduce the duration of influenza A illness by approximately one day compared with placebo. The usual recommended duration of treatment is five days.

Chemoprophylaxis
Known exposure: For chemoprophylaxis of known exposure, treatment should begin within 2 days of contact with an infected individual and continue for two weeks.

In lieu of vaccination: To be maximally effective as prophylaxis in lieu of vaccination, influenza antiviral medications must be taken each day for the duration of influenza activity in the community. However, one study of amantadine or rimantadine prophylaxis reported that the drugs could be taken only during the period of peak influenza activity in a community.

Outbreak in an institution: For residents of an institution, chemoprophylaxis is recommended during an outbreak, and should be continued for at least two weeks. If surveillance indicates that new cases continue to occur, chemoprophylaxis should be continued until approximately one week after the end of the outbreak.

Dosage:

Recommended Daily Dosage of Influenza Antiviral Medications for Treatment and Prophylaxis3

Antiviral Agent Age Groups (yrs) 13-64 >65

Amatadine* (Symmetrel ®)
Treatment, influenza A
Prophylaxis, influenza A


100mg twice daily §
100mg twice daily §


< 100 mg/day
< 100 mg/day

Rimantadine (Flumadine®)
Treatment, **influenza A
Prophylaxis, influenza A


100mg twice daily §
100mg twice daily §


< 100 mg/day
< 100 mg/day

Zanamivir***††† (Relenza®)
Treatment, influenza A and B


10mg twice daily
10mg twice daily

Oseltamivir (Tamiflue®)
Treatment,§§§ influenza A and B
Prophylaxis, influenza A and B


75mg twice daily
75 mg/day
75mg twice daily
75mg/day

* The drug package insert should be consulted for dosage recommendations for administering amantadine to persons with creatinine clearance < 50 ml/min/1.73m 2.

† 5 mg/kg of amantadine or rimantadine syrup = 1 tsp/22 lbs.

§ Children > 10 years who weigh <40 kg should be administered amantadine or rimantadine at a dosage of 5 mg/ kg/day.

A reduction in dosage to 100 mg/day of rimantadine is recommended for persons who have severe hepatic dysfunction or those with creatinine clearance < 10 mL/min. Other persons with less severe hepatic or renal dysfunction taking 100 mg/day of rimantadine should be observed closely, and the dosage should be reduced or the drug discontinued, if necessary.

** Only approved by FDA for treatment among adults.

§§ Rimantadine is approved by FDA for treatment among adults. However, certain experts in the management of influenza consider it appropriate also for treatment among children. (See American Academy of Pediatrics, 2000 Red Book.)

Older nursing-home residents should be administered only 100 mg/day of rimantadine. A reduction in dosage to 100 mg/day should be considered for all persons aged > 65 years if they experience possible side effects when taking 200 mg/day.

*** Zanamivir administered via inhalation using a plastic device included in the medication package. Patients will benefit from instruction and demonstration of the correct use of the device.

††† Zanamivir is not approved for prophylaxis.

§§§ A reduction in the dose of oseltamivir is recommended for persons with creatinine clearance <30 ml/min.

http://www.cdc.gov/flu/professionals/antiviralback.htm

Further Claims Preparation Instructions
Because Medicare carriers will hold claims received until Medicare systems changes are made on January 17, 2005, interest will be paid to providers, where applicable, when the held claims are processed on or after January 17, 2005. In addition, physicians, providers, and suppliers should note the following:

For complete details, please see the official instruction issued to your carrier/intermediary regarding this change.

That instruction may be viewed by going to http://www.cms.hhs.gov/manuals/transmittals comm_date_dsc.asp

From that Web page, look for CR3696 in the CR NUM column on the right, and click on the file for that CR.

If you have any questions, please contact your carrier/intermediary at their toll-free number, which may be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf

Look-Up Table For Calculating Beneficiary Co-Payment for Antiviral Influenza Treatment

INSTRUCTIONS FOR USING THIS TABLE
NOTE: This table is only used to calculate the beneficiary co-payment amount for those participating in the Medicare Drug Discount Card Program.

  1. Locate the name of the Medicare Drug Discount Card Sponsor in column A, or the Sponsor’s plan number in column B.
  2. Locate the prescribed medicine in column C through I.
  3. Find the cost per unit for the prescribed medicine for the specific Card Sponsor.
  4. Multiply the unit cost of the medicine by the number of units in the prescription, PLUS $1.00, to calculate the total Drug Card Sponsor’s cost.
  5. Multiply the Medicare Allowed Payment Amount by the number of units in the prescription to
    calculate the Medicare allowed cost.
  6. Compare the total cost of the Drug Card Sponsor with the total cost of the Medicare allowed cost.
  7. If the total Medicare allowed cost is less than the total Drug Card Sponsor’s cost the co-payment will be 20% of the Medicare Allowed cost.
  8. If the total Drug Card Sponsor’s cost is less than the Medicare allowed cost the co-payment will be 20% of the Drug Card Sponsor’s costs.

** In either case Medicare will reimburse the pharmacy 80% of the Medicare allowed cost.

Related Change Request #: 3696 Medlearn Matters Number: MM3696
Disclaimer

Medlearn Matters articles are prepared as a service to the public and are not intended to grant rights or impose obligations. Medlearn Matters articles may contain references or links to statutes, regulations, or other policy materials.

Medicare Allowed Payment Amount   $0.76 $0.76 $1.32 $5.43 $1.65 $2.17 $6.99
(includes 5% or 10% reduction from AWP) (per 10mg)   (per 10mg)      
A B C D E F G H I
Plan Name Dnum AMANTADINE 100MG ADANTADINE 100MG FLUMADINE 100MG RELENZA MG RIMANTADINE 100MG SYMMETREL 100MG TAMIFLU 75MG
Anthem Drug Discount Card D7000 0.0746 0.144 0.4147 0.4689 0.22 0.2423 1.2348

MedCare
USA, Powered
by MedImpact

D7001 0.0864 0.2113 0.4195 0.4901 0.3227 0.2451 1.2622
aClaim
RxSavings
Club 		D7002 0.0871 0.168 0.4147 0.4689 0.2567 0.2545 1.3328
Ameri-Health RxSavings D7005 0.1082 0.2089   0.4954 0.2545 1.2831  
InStil Health Solutions
Prescription Advantage		 D7007 0.0864 0.2113 0.4195 0.4901 0.3227 0.2451 1.2622
Health Spring of Alabama D7008 0.0994 0.2112 0.4195 0.4765 0.3224 0.2574 1.2562
Health Spring of Illinois Prescription Advantage D7009 0.0994 0.2112 0.4195

0.4765

 0.3224 0.2574 12.562
Health Spring Prescription Advangage D7010 0.0994

0.2112

0.4195

0.4765

0.3224

 0.2574 1.2562
Texas
Health-
Spring
Prescription
Advantage
 D7011 0.0994 0.2112 0.4195 0.4765 0.3224 0.2574 1.2562
Horizon RxSavings D7013 0.1082 0.2089   0.4954   0.2545 1.2831
Priority
Plus		 D7015 0.0871 0.168 0.429 0.4932 0.2567 0.2633 1.2685
PBM
Plus
Senior
Care		 D7016 0.1181 0.2401 0.4767 0.5561 0.3024 0.2925 1.532
The
Pharmacy
SmartCard		 D7017 0.056 0.13 0.4147 0.5182 0.275 0.2423 1.3328
My1.
Pharma
Care 		D7019 0.1028 0.2089 0.4147 0.4787 0.3187 0.2423 3328
Liberty
Prescription
Discount Card		 D7020 0.0933 0.18 0.4147 0.4787 0.275 0.2423 1.2348
Script-
Save
Premier
 D7021 0.1119 0.2161 0.429 0.5063 0.33 0.2507 1.3137
Blue
Cross
Blue
Shield
of
Alabama’s
BlueRx
 D7027 0.0889 0.2089 0.4147 0.4787 0.2794 0.2545 1.2348
Aetna
Rx Savings
Card (SM)		 D7028 0.1119 0.2161 0.429 0.5063 0.33 0.2507 1.3137
Rx-
Savings
distributed
by Reader’s Digest		 D7029   0.1119 0.2161 0.5483   0.2779 1.4171
Rx-
Savings
distributed
by
Reader’s
Digest		 D7029 0.1121 0.2401   0.5956   0.2925 1.4937
Rx-
Savings
distributed
by MCS
Life
Insurance
Company		 D7030 0.1121 0.2401   0.5956   0.2925 1.4937
Anthem
Drug
Discount
Card VA		 D7031 0.0746 0.144 0.4147 0.4689 0.22 0.2423 1.2348
Anthem
Drug
Discount
Card NH		 D7032 0.0746 0.144 0.4147 0.4689 0.22 0.2423 1.2348
Anthem
Drug
Discount
Card CO		 D7033 0.0746 0.144 0.4147 0.4689 0.22 0.2423 1.2348
Anthem
Drug
Discount
Card IN
 D7034 0.0746 0.144 0.4147 0.4689 0.22 0.2423 1.2348
Anthem
Drug
Discount
Card ME		 D7035 0.0746 0.144 0.4147 0.4689 0.22 0.2423 1.2348
Anthem
Drug
Discount
Card KY		 D7036 0.0746 0.144 0.4147 0.4689 0.22 0.2423 1.2348
Anthem
Drug
Discount
Card OH		 D7037