Fall 2019

Neighborhood News

Helping Your Patients to Better Understand the Flu Shot

Claims Corner

  • Adjustment Request Form
  • Electronic Reconsideration Correspondence
  • Certified Mail
  • Current Forms
  • Claim Submission Reminders for Providers and Billers

Closing Your Practice to New Members

Cognitive Assessment Screening for Eligible INTEGRITY Members

Tobacco Cessation: Making a Difference in Members’ Health

Pharmacy Department Update

  • Biosimilars
  • Pharmacy website resources
  • 340B billing
    • If you are billing the pharmacy benefit for a 340B claim, please follow the stated guidance to properly submit the claim
      • NCPDP Data ELEMENT 409-D9: Ingredient Cost Submitted = 340B Acquisition Cost
      • NCPDP Data Element 420-DK: Submission Clarification Code = 20
    • If you are billing the medical benefit for a 340B claim, please follow the stated guidance to properly submit the claim
      • Modifier: UD
      • Description: Medicaid level of care 13, as defined by each state