Argus
Bulletin
Health Partners: Multi-Ingredient Compound Processing
Communication #06BR10
BIN: 600428
PCN: 02530000
Date
: January 28, 2010
Effective Date:
February 15, 2010
Summary
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On February 15, 2010, Multi-Ingredient Compound Logic will be implemented into claims processing methodology for Health Partners.
What You Need to Know
Multi-Ingredient Compound Logic will be implemented into claims processing methodology for Health Partners.
Beginning on February 15, 2010, pharmacies will have the opportunity to process compounds using the Multi-Ingredient System. Your pharmacy will need to implementthe appropriate processing guidelines to continue to process compound claims in thefuture. If this is not implemented your pharmacy could see a high error rate with denied claims.
The Health Partners payer sheet will be updated in the future to reflect the change in our compound processing. Until that time, please reference the “Multi Ingredient Compound Generic” payer sheet for processing information. You may find the Health PartnersPayer Sheet at the following website: http://argushealth.com
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Click MyArgus link in the upper left-hand corner of the website.
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Enter the User ID and the password.
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Select the Pharmacy Icon.
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Select the payer sheet.
Pharmacies will continue to process compounds with the compound indicator of "02"
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Each NDC will be reviewed based upon submission, applying contractual pricing and existing drug benefits per ingredient. The sum of the calculated ingredient cost from each ingredient will be populated in the Plan Ingredient Cost. If the sum of the calculated ingredients that compose the compound exceeds the max dollar amount the claim will deny and require approval.
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Common compound ingredients and other agents (OTC products) will process only if submitted with an approved most expensive ingredient NDC. The pharmacy should process the compound with a submission clarification code of ‘08’ for these ingredients. Please be advised that any excluded NDC’s will be omitted from the pricing calculation.
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Vendor will need to update Compound Segment AM10.
Health Plan BIN PCN
Health Partners 600428 0253000
Please work with your pharmacy vendor in order to assure all appropriate fields are populated during the claims transmission of compound claims.
Action Required
There is a max of 25 NDC’s for the Multi-Ingredient Compound system.
If you have any questions, please contact the Pharmacy Network Administration at
1-800-553-0784
All of the information on this page constitutes a trade secret, privileged or confidential information,
as such terms are interpreted under the Freedom of Information Act and applicable case law.
Argus Health Systems, Inc.
1300 Washington St.
Kansas City, MO 64105-1433
www.argushealth.com
©2010 by Argus Health Systems, Inc. All Rights Reserved. The computer systems, procedures, databases, software
programs, documentation and other materials (collectively "Information") created, maintained or provided by Argus
Health Systems, Inc. ("Argus"), are proprietary to Argus and are confidential. 06BR10
All of the information on this page constitutes a trade secret, privileged or confidential information,
as such terms are interpreted under the Freedom of Information Act and applicable case law.
Quick Reference:
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‘02’.