Providers Portal

Provider Log In
Pharmacy Help Desk 
ACAA 1-866-224-0176
AHM 1-855-831-3592
EVERTEC
1-844-804-7414
First Medical 1-855-831-3591
First+Plus 1-855-831-3595
PICA 1-866-993-7422
PSM 1-855-831-3594
PROSSAM 1-855-831-3593
TSS 1-855-922-2722
UPR 1-866-578-7274
Compliance & FWA  
Hotline             1-855-831-3596

 

Plan Sponsor Announcements

New Client Effective October 1, 2014 - EVERTEC - See document for processing requirements (e.g., RxBIN, RxPCN, RxGroup).

Cliente nuevo efectivo 1 de octubre de 2014 - EVERTEC - Ver documento para requerimientos de procesamiento (e.g., RxBIN, RxPCN, RxGroup).

Triple S Medicare, American Health Medicare and PICA Formulary Changes – Effective October 1st, 2014

Triple S Medicare, American Health Medicare and PICA Formulary Changes – Effective September 1st, 2014


Compliance & FWA Resources

Medicare Compliance and FWA Training (English) (revised 03/2014)

2014 FWA Attestation_SPA (Español) (revisado 03/2014)

Q4-13 Avoiding Common Billing Errors (11/2013)

Q1-14 Prevention of Fraud, Waste, and Abuse in Pharmacies (03/2014)

Q2-14 Guide for Billing Topical Medications (07/2014)

General Pharmacy Operations Resources

Health Care Claim Payment Provider Manual (EOP X12 835)
 

American Health, PICA, and Triple S Medicare Coverage Determination Request Form_ENG (English) (revised 12/2013)

American Health, PICA, and Triple S Medicare Coverage Determination Request Form_SPA (Español) (revisado 12/2013)

First Plus Coverage Determination Request Form_ENG (English) (revised 12/2013)

First Plus Coverage Determination Request Form_SPA (Español) (revisado 12/2013)

Drug Price Appeal Request Form (English) (revised 07/2014)

Solicitud de Apelación de Precio de Medicamentos (Español) (revisado 07/2014)

Manual Reversal Request Form (English) (revised 03/2013)

Solicitud de Reverso Manual (Español) (revisado 01/2013)

Pharmacy Manual (English) (revised 05/2014)

ACH Set-up Form (revised 03/2014)

Registro de Firmas de Reclamaciones de Farmacia

Pharmacy Rejection Codes - No-Charge Rejection Codes (revised 01/2013)

NCPDP Universal Claim Form - Sample and Instructions

CMS Beneficiary Pharmacy Notice for Medicare Part D Beneficiaries

Notificación de CMS de Farmacia para los Beneficiarios de Medicare Parte D

Formulario de Quejas (Pharmacy Provider Complaint Form)

Payer Sheets

Medicare Part D Plans Payer Sheet (revised 8/27/2014)

Commercial/ Non-Medicare Plans Payer Sheet (revised 12/18/2012)