Date: March 16, 2017
To: Participating Pharmacies, Physicians, Dentists, Podiatrists, Optometrists, Hospitals, Advanced Practice Nurses, and Physician Assistants
Re: Point of Sale (POS) System Outage & New POS Payor Sheet
This notice is to inform you that the Illinois Department of Healthcare and Family Services has adjusted the implementation date and time for the new Pharmacy Benefit Management System (PBMS). The new implementation date is Sunday, March 26th at 5:00 pm CDT. This implementation will require pharmacy providers to update information currently submitted for NCPDP D.0 claim transactions.
An updated payor sheet can be found on the Department’s Payor Sheet webpage. Pharmacies are encouraged to pay particular attention to the Coordination of Benefits/Other Payments Segment Questions section of the payor sheet.
In addition, the Bank Identification Number/Processor Control Number (BIN/PCN) will change effective with implementation of the new PBMS. The new BIN and PCN are listed below.
- BIN - 017804
- PCN - ILPOP
All claims submitted, including historical reversals and resubmissions after the implementation of the new PBMS, must include the new BIN and PCN. Providers submitting claims using the current BIN and PCN will receive the error messages listed below.
- NCPDP Reject 01: Invalid BIN. Use 017804
- NCPDP Reject 04: Invalid PCN. Use ILPOP
As part of this implementation, the Illinois Medicaid Pharmacy Point of Sale (POS) system will be unavailable beginning at 5:00PM CDT Saturday, March 25th through 5:00 PM CDT Sunday, March 26th. Pharmacy claims will not be adjudicated during this time. Pharmacies should hold all claims during this time for submission after 5:00 PM CDT on Sunday, March 26th.
In addition, the various avenues for submitting prior authorization requests listed below will not be available after 3:00 PM CDT on Friday, March 24th.
· Prior Authorization/Refill Too Soon (PARTS) Hotline
· Four Script Prior Authorization Request Web Application
· Medical Electronic Data Interchange (MEDI)
The PARTS Hotline will reopen beginning at 8:30 AM CDT on Monday, March 27th.
The Web Application and MEDI will no longer be available for submitting prescription prior authorization requests. HFS encourages users of those options to enroll in and use the new PBMS Provider Portal to submit prior authorization requests. Further information regarding the registration process for the Provider Portal will be forthcoming via email the week of March 20th.
This information is being sent in advance to allow time for providers to process prescriptions and refills needed by medical programs participants prior to the scheduled downtime to avoid any potential interruptions of care.
Changes to the payor sheet for data submission will be effective on March 26, 2017. Guidance for all of the POS changes is included within the payor sheet.
Questions regarding this provider notice should be directed to the Bureau of Professional and Ancillary Services’ pharmacy billing consultants at 877-782-5565.
Felicia F. Norwood
Director
