Medicare and Medicaid Prescription Drug Information
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. Two plans that may cover prescriptions are Medicare Part B and Part D.
Information for Members
If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
Information for Providers/Pharmacist
Medicare Part B and Part D drugs will not be covered by the Kentucky Department for Medicaid Services. These claims will deny with NCPDP Error Code 41 and the supplemental message of "Submit bill to other process or primary payer" with the additional message "Bill Medicare Part D; Other payer not cost avoided."
For questions regarding crossover billing that is not part of the POS system, Please contact Hewlett-Packard (HP) at (800) 807-1232.