The Tennessee Pharmacists Association (TPA) has been working with TennCare and Magellan regarding the recent letter that was sent to pharmacists. In order to help TennCare and Magellan to address this issue, TennCare has requested that pharmacists send specific examples of the following to the attention of Dr. James “Rusty” Hailey and Dr. Raymond McIntire.
Please provide them with specific examples of the following:
- Claims that were sent to pharmacists by Magellan for further consideration because other primary insurance existed, but upon further examination, the individuals were truly TennCare only (i.e., no credible coverage existed with a primary insurer at the time of the original claim submission). One example might be that the patient’s primary insurance ended in 2013 but the claims provided to the pharmacist from Magellan were from 2014.
- Claims where the pharmacist contacted the Magellan helpdesk and received instructions from the helpdesk to input the Other Coverage Code of 1 to get the claims to process.
- Claims which have been rejected because the system recognizes a prescription discount card as an insurance card.
- Claims that have been rejected by a patient’s primary insurance as “Claim Too Old”.
TPA appreciates the help and assistance of TennCare and Magellan in resolving this issue. This request is very urgent, so TPA is asking for the assistance of all pharmacists to communicate these issues back to TennCare as soon as possible.