Attention Enrolled Pharmacies: 2^nd Communication
Effective 10/01/2000 Express Scripts will be administering the Pharmacy Benefit Program for the State of Georgia, Department of Community Health, Medicaid and PeachCare for Kids Programs.

For pharmacy benefit inquiries, prior authorization, and clinical overrides, call toll-free, 877.650.9340. Express Scripts is available 24 hours a day, 7 days a week, 365 days a year.

For remittance, check and EFT inquiries, call Express Scripts Provider Relations toll-free at 866.296.9943. For Medicaid provider enrollment, contact ACS at 404.298.1228 or toll-free at 800.766.4456. The application for Medicaid Provider Enrollment can also be obtained from the Georgia Health Partnership.

The Georgia license number of the prescribing physician must be entered when submitting claims. This number may be obtained from the Georgia Composite State Board of Medical Examiners website. Exceptions will be made in the following locales:

PDO300 = Podiatrists, Dentists, Optometrists

GHS300= Grady Health System Hospital, Clinics, Emergency Rooms

AOH300= All Other Hospitals, Clinics or Emergency Rooms

AOS300= All Out-of-State Providers

ANP300= All New Physician License Number (Granted within the last 60 days)

Third Party Liability/ Coordination of Benefits (COB)

• Members must present other carrier coverage cards if they have other coverage.
  
  
• Pharmacies must submit any claims to other carriers first. Medicaid is the payor of last resort.
  
  
• After the other carrier pays, submit to Express Scripts any remaining balance due on a universal claim form (UCF).

(Mail to: ESI-GDCH Paper Claims, P.O. Box 390863, Bloomington, MN 55439.)

• Effective 10/01/00 all pharmacies will be required to submit claims online or using the universal claim form (NCPDP UCF). Batch, bulletin board, dial-up, diskette, or cartridge claims will not be processed.
  
  
• If your pharmacy currently has the ability to bill claims online but needs assistance in set-up with Express Scripts, please contact your software vendor.
  
  
• Effective 10/1/00 emergency prescription automated overrides (99888) due to lost, stolen, or mid-month dose change prescriptions will be allowed at a maximum of six times per calendar year per drug. This override code cannot be used for prior authorization (PA) overrides or therapy limits.
  
  
• When submitting paper claims on the NCPDP UCF form include NCPDP number and Medicaid provider ID, prescribing physician license number, member ID, date of birth, gender, date of service filled, Rx number, NDC number, quantity, days supply, and ingredient cost. Also, include PA override number or automated override code if applicable.