Issue Solution
 If ...
 Then ...
Cardholder ID is invalid.   Submit
• Using plan code according to logo
• Using correct ID number as stated on card
• Using correct group number

If still rejected, refer the cardholder to his or her benefits administrator.
Cardholder has termed.

• Ask if cardholder presented a current card.
• Ask if cardholder has other primary coverage.
• If still rejected, refer the cardholder to his or her benefits administrator.

Member wants to fill a prescription for a vacation supply or lost medications.

• Call the appropriate pharmacy help desk for assistance to determine whether group allows for override.
Prior authorization is required. • Advise cardholder to have his or her doctor call the customer service number printed on the card and give the diagnosis.
Refill is too soon.

• Change direction for medication. Enter "98798798798" into the prior authorization field and resubmit the claim.

The prescription is for interferon beta-1b (Betaseron®).

• Submit claims online to HDS (Bin#610500).
• For assistance with inquiries, contact HDS at 800.750.9835.

Day supply is invalid or quantity is rejected.

• Verify that the day supply, directions, and quantity fields are all consistent with the written prescription.
• Check online messaging for plan limitations.

 If processing this logo ...
 Then verify ...

• Express Scripts or PERx Plan input code
• Processor control field (BIN#003858 and A4 should be entered)
• Group number (required if it appears on the card)
• Cardholder ID number (should match the card)

• DPS plan input code
• BIN#900002 for Envoy
• BIN#400004 for NDC
• BIN#002156 for MedE America
• Group number (required if it appears on the card)
• Cardholder ID number (should match the card)

• ValueRx plan input code
• BIN#610041
• Group number (required if it appears on the card)
Cardholder ID number (should match the card)