Effective for dates of process on and after September 1, 2006, Wisconsin Medicaid will enforce the previously published coordination of benefits policy for SeniorCare participants who are also enrolled in Medicare Part D. This policy was introduced in the January 2006 Wisconsin Medicaid and BadgerCare Update (2006-05), titled “Coordination of Benefits for SeniorCare Participants Enrolled in Medicare Part D.”
Effective for dates of process on and after September 1, 2006, Wisconsin Medicaid will enforce the previously published coordination of benefits policy for SeniorCare participants who are also enrolled in Medicare Part D. This policy was introduced in the Wisconsin Medicaid and BadgerCare Update (2006-05), titled “Coordination of Benefits for SeniorCare Participants Enrolled in Medicare Part D.”
Implementation of Informational Response
Beginning August 1, 2006, pharmacy providers will receive the informational Explanation of Benefits (EOB) message 374 on claim submissions for drugs when a SeniorCare participant also has Medicare Part D. This response will state the following:
“Participant is enrolled in Medicare Part D. Beginning 9/1/06, providers are required to bill Part D and other payers prior to SeniorCare, or SeniorCare will deny the claim.”
Implementation of Hard Edit
For dates of process on and after September 1, 2006, when a claim for a SeniorCare participant is denied because the participant is also enrolled in a Medicare Part D Prescription Drug Plan (PDP), providers will receive EOB message 268, which states the following:
“Participant is enrolled in Medicare Part D for DOS. Submit claim to participant’s PDP prior to SeniorCare. PDP payment/denial information required on claim to SeniorCare.”
Providers will be required to submit claims for SeniorCare participants who are enrolled in a Medicare Part D PDP to the participant’s PDP and other health insurance sources before submitting claims to SeniorCare. SeniorCare is the payer of last resort.
Claims Submission
Pharmacy providers are required to submit claims to the appropriate PDP for participants in all levels of participation. Providers are also required to indicate the outcome of the claim response from the PDP to SeniorCare.
For More Information
Refer to Attachment 1 and Attachment 2 of this Update for the following:
- SeniorCare and Medicare Part D frequently asked questions that providers may distribute to SeniorCare participants.
- A SeniorCare claim submission quick-reference guide.
Attachment 1 — SeniorCare Frequently
Asked Questions Related to Medicare Part D
Attachment 2 — SeniorCare and Medicare
Part D Coordination of Benefits Quick Reference
