michigan medicaid pharmacy help desk

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information about the Department's public safety programs. Call the toll-free numberon yourHealth Plan ID card. Information on resources in your community and volunteer recruitment and training, and services provided at local DHS offices. A variety of reports & statistics for programs and services. Please select your State below to view state-specific contact information. Getting started is easy. What has to be submitted with a MAVYRET claim now that no PA is required? The Center for Medicaid and CHIP Services (CMCS) is committed to working in close partnership with states, as well as providers, families, and other stakeholders to support effective, innovative, and high quality health coverage programs. , was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription drugs. Medicaid is a joint Federal-State program that pays for medical assistance for individuals and families with low incomes and relatively few assets. Under the Common Formulary, Medicaid Health Plan formulary coverage is limited to products with a National Drug Code from manufacturers who participate in the Medicaid Drug Rebate Program. Information on treatment and services for juvenile offenders, success stories, and more. A: You must file a grievance with the health plan. and a health ID card from that Health Plan. Universal caseload, or task-based processing, is a different way of handling public assistance cases. National Coverage Determination (NCD) for Routine Costs in Clinical Trials. The links below may include unofficial information for use in Program Development. Q: How canMICHIGAN ENROLLS help me? 2022 Medicare and PDP Compare Plans and Enroll Now 2023 . It is open 24 hours a day, seven days a week. Quality, Safety & Oversight - General Information. Low-income Households Water Assistance Program (LIHWAP). Toll-Free: 877-267-2323. Fee-for-Service pharmacy claims are processed by ODM's contracted pharmacy benefits administrator (PBA) in an online, real-time environment which allows the dispensing pharmacist access to the terms of coverage. Box 516, Essington, PA 19029. Share sensitive information only on official, secure websites. MeridianRx would love to hear from you! Governor's Goals. It'scalled themihealth card. If the rules for that drug are met, we will cover the drug. Local: 410-786-3000. MDHSS carves out specific classes of drugs. (Pharmacy) 354-NX SUBMISSION CLARIFICATION CODE COUNT Maximum count of 3. We're here to help. Centers for Medicare and Medicaid Services Monday through Friday, from 9:00 a.m. to 4:30 p.m. 1414 E. Maple Road. You might be eligible depending on your household income, family size, age, disability, and other factors. Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. The claim will be paid if submitted in accordance with our Pharmacy Claims Processing Manual: Will MAVYRET be covered without a PA in the rare case a patient requires 12 weeks of therapy? Maternity Outpatient Medical Services (MOMS) Questions and Answers: Q: What is the MOMSprogram? A: Contact your Health Plan to change your PCP. Q: Where can I apply forMIChild? Healthy Michigan Plan; Pharmacy Benefits . CMS Fast Facts. The Prior Authorization criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring PA is below: A standard prior authorization form, FIS 2288, was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription drugs. There are two categories of coverage, preferred and non-preferred. Information about the health care programs available through Medicaid and how to qualify. For members enrolled in the Healthy Indiana Plan (HIP), Hoosier Care Connect and Hoosier Healthwise managed . Then mail or return the Application to your local M, The Department of Health and Human Services (MDHHS) has implemented a pilot policy for MDHHS administrative hearings in three counties. Heres how you know. In addition, certain drugs on the formulary have quantity limits. You must be a United States (U.S.) citizen, a U.S. national, or have a satisfactory immigration status to be eligible for full benefits. In the event a particular product is not approved, the dispensing pharmacist can notify the prescriber of possible alternatives. We're available Monday through Friday 9 a.m. - 4 p.m Employer Small Business Sales 800.471.2504, option 4 or through an independent licensed Priority Health agent Medicare 888.230.0372 (TTY 711) 8 a.m. to 8 p.m., 7 days a week Medicaid MIChild 888.988.6300 (TTY 711 ) Lansing, MI 48909-7979. If you receive a denial, reduction or termination in medical benefits or if you disagree with an adverse benefit determination made by an MDHHSmanaged care entity (health or dental plan, CMHSP/PIHP, MHL or waiver program), you have the right to ask for an appeal with that managed care entity. For Medicaid, co-pay for MAVYRET is $1, and co-pay for non-preferred DAAs are $3. For additional information about our pharmacy network, call the MeridianRx Pharmacy Help Desk at 855-323-4580 (TTY users should call 711). Birth, Death, Marriage and Divorce Records. Health and AgingServices Administration Pharmacy Services Help Desk Monday - Friday 8:00 AM - 4:30 PM Phone: 1-800-537-8862. The PDL is a listing of drugs that are covered by Michigan Medicaid. The next Michigan Medicaid Health Plan Common Formulary public comment period will be announced here. Information is collected to monitor the general health and well-being of Michigan citizens. For more information about MDHSS Fee-for-service carve outs please click here. Providers: 1-855-580-1689 (TTY 711) Monday-Friday, 8am to 8pm CST. SSM information can be found in the plan's Evidence of Coverage. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. For questions about ID cards, benefits, claims or other issues: Call the number on the back of your member ID card or 313-225-9000. PROVIDER. Over-the-counter drugs must have a prescription for them to be covered at no cost to our members. MICHIGAN. 1-888-417-3479. 1-888-373-7888 233733 More Information on human trafficking in Maryland Information on the Family Independence Program, State Disability Assistance, SSI, Refugee, and other cash assistance. Medicaid Drug Rebate Program Labeler List Reference - To help you more easily identify Medicaid rebatable NDCs, we are posting a monthly reference list here . Information about the health care programs available through Medicaid and how to qualify. A federal program which helps persons admitted into the U.S. as refugees to become self-sufficient after their arrival. Blue Cross Complete of Michigan 4000 Town Center Suite 1300 Southfield, MI 48075 . If you're a provider who needs to contact us about one of our Blue Cross Blue Shield of Michigan, Blue Care Network or our Medicare products, start here. A:You will get a information packet in the mail from MICHIGAN ENROLLS. MEMBER. Medicare Acronyms Lookup Tool. Use the Find My Plan tool to access your patient's plan. Prescription Drugs. Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. TTY Toll-Free:800-877-8339 Notice: Pharmacy Helpline . Information on resources in your community and volunteer recruitment and training, and services provided at local DHS offices. Information on the Children's Foster Care program and becoming a Foster Parent. It will also have instruction on how toenroll ina Health Plan and choose a Primary Care Provider (Doctor). Members can order refills by mail, by phone, online, or they can sign up for automatic refills. This site, managed by Magellan Medicaid Administration on behalf of the Michigan Department of Health and Human Services, provides important information about the Michigan Medicaid Pharmacy Services program. MDHHS is partnering Aetna Better Health in the We Treat HEP C Initiative. Fax: 877-355-8070. MAVYRET is covered for beneficiaries on Emergency Service (ESO) Medicaid. What is the co-pay for a non-preferred DAA? Evidence-Based Care. Members previously enrolled in Sacramento County's LIHP program can call Sacramento County Department of Human Assistance at 916-874-9238 for any assistance. Your Health Plan should have list of doctors, pharmacy, hospital, or other medical providersthat participate withthem. A:Contact your local Health Department. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer. Apply on-line or print, complete and mail the DCH-1426 form You can call or go to your local Department of Health and Human Services (MDHHS) to get an application. Information on Safe Sleep for your baby, how to protect your baby's life. Adult & Children's Services collapsed link, Safety & Injury Prevention collapsed link, https://dev.michigan.local/som/json?sc_device=json, Pre-Single PDL Changes (before October 1, 2020), Post-Single PDL Changes (after October 1, 2020). Find a Pharmacy. Information about the Michigan law that requires certain information be made available to a woman who is seeking an abortion at least 24 hours prior to the abortion procedure. . Or. Information about audits conducted by the Office of Audit. Licensing information for Adult Foster Care and Homes for the Aged, Child Day Care Facilities, Child Caring Institutions, Children's Foster Care Homes, Child Placing Agencies, Juvenile Court Operated Facilities and Children's or Adult Foster Care Camps. They can: CVS Health Mail Order Service FormEnglish / Spanish. Itwill list theHealth Plan choices in your county. Utilize interactive health and wellness tools to help you manage conditions, improve your health and save money. Programs for healthy children & families, including immunization, lead poisoning prevention, prenatal smoking cessation, and many others. If a NDC for a non-MDRP participating labeler is adjudicated on a pharmacy claim, NCPDP error AC (Product Not Covered non-Participating Manufacturer) will be included in the reject messaging. Drugs that are listed under the common formulary have criteria listed here. SSM information can be found in the plan's Evidence of Coverage. Choose ways to enroll: PharmacyPrior Authorization Faxnumbers:1-855-799-2551, Disease-specific education and counseling by the CareTeam, Delivery of Specialty drugs to your patients home and/or your office in temperature-controlled packaging with the required supplies, i.e. Information on the Family Independence Program, State Disability Assistance, SSI, Refugee, and other cash assistance. 7500 Security Boulevard Pharmacists and Providers may clickherefor additional COVID-19 therapeutic information. Welcome to the Pharmacy Services website for the Michigan Medicaid program. Lansing, MI 48909 The PDL is a listing of drugs that are covered by Michigan Medicaid. This form or a prior authorization used by a health plan may be used. Live Chat for Members Log in to your Anthem account to discuss your questions with a live representative. This will help you get your prescription coverage. Need help with your login or our website? Healthy Michigan Plan 1 Campus Martius, Suite 700 . Our phone lines are open 24 hours a day, seven days a week. Will there be specific PA criteria listed in the PDL for the non-preferred DAAs? Can patients fill their MAVYRET prescription at any Specialty or Retail Pharmacy? If you'd like a hard copy mailed to you, call Pharmacy Customer Service at 1-888-288-3231. CMSis a Federal agencywithin theU.S. Department of Health and Human Services. PO Box30479 Network pharmacies have also been made aware of the changes to the PA status of Mavyret and should be prepared to dispense accordingly. The MDHHS will determine your eligibility for Medical Assistance. Medicaid Pharmacy Trend Report; MRx Pipeline; MRx Trend Alert; MRx Clinical Alert; Subscribe; Cool News Features; Magellan Health Insights; Watch. Information on the Children's Foster Care program and becoming a Foster Parent. Q: Do Healthy Kids beneficiariesget ahealth ID card? Q: Where can I apply forMOMS? Birth, Death, Marriage and Divorce Records. Click here to locate your Local Health Department and WIC agency. When state criteria does not exist, the guidelines contained inthis chart are utilized. Denied a covered Medicaid, Healthy Michigan Plan,or CSHCSbenefit. Medicaid Health Plans apply the optional effective date for new/reinstated labelers. You can check our health planwebsite to confirm PA requirements on the medications listed below. Not all covered drugs are listed on the PDL, MDHSS still covers drugs through the Michigan Medicaid Common Formulary. Information on the Food Assistance Program, eligibility requirements, and other food resources. Information & resources for Community and Faith-Based partners. Click here for Request for Departmental Review (DCH-0892). Q: Where can I find out which doctors, pharmacy, hospital, or other medical providers participate withmy Medicaid Health Plan? Members can talk with pharmacists by phone at any time 24 hours a day, 7 days a week. Information on Safe Sleep for your baby, how to protect your baby's life. If you need assistance in any of the areas noted, you will need to contact the agency for Medicaid/CHIP in your state of residence or the state you have questions about in order to receive assistance. Or call the medical provider. Q: Do Medicaid beneficiariesget ahealth ID card? How do I apply for theHealthy Kids program? Q: Where can I find more information on Healthy Kids program? Headquarters Multi-Agency State Office Building 195 North 1950 West Salt Lake City, Ut 84116. Chat Now is no longer available, please call the number on the back of your card to get further assistance. Members, log in to find information specific to your plan or start a Live Chat. Q: Do Healthy Kids beneficiariesget ahealth ID card? Bridge Card Participation Information on Electronic Benefits for clients and businesses, lists of participating retailers and ATMs, and QUEST. Information on adoption programs, adoption resources, locating birth parents and obtaining information from adoption records. Many states have expanded their Medicaid programs to cover more low-income adults. Members: 888-437-0606 (TTY 711) Providers: 888-773-2647 (TTY 711) Healthy Michigan Plan's regular business hours are Mon - Friday 8am-6:30pm EST. Information on treatment and services for juvenile offenders, success stories, and more. This change is because of a MDHHS policy change and effects all Michigan Medicaid Health Plans. Denied a covered Medicaid(CSHCS) benefit. October 3, 2022 Stakeholder Meeting Presentation, Stakeholder Meeting Questions and Answers, Frequently Asked Questions for Drug Manufacturers, Drug Class & Workgroup Review Schedule for 2022. Healthy Michigan Plan. Adult Behavioral Health & Developmental Disability Services. A federal program which helps persons admitted into the U.S. as refugees to become self-sufficient after their arrival. Non-preferred DAAs will require a PA explaining why MAVYRET is not clinically appropriate: MIRx_PAfaxform_General.pdf (magellanrx.com). HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. ), will they be able to complete their course of therapy (i.e., refills)? You can alsocall your localMDHHSfor more information. A provider can submit a request either by phone, by fax, or by Real Time Prior Authorization via EHR to Health First Colorado's Prior Authorization Helpdesk. The Michigan Domestic & Sexual Violence Prevention and Treatment Board administers state and federal funding for domestic violence shelters and advocacy services, develops and recommends policy, and develops and provides technical assistance and training. Information on the Safe Delivery Program, laws, and publications. If you dont have contact information for your state, you can find provider enrollment information here. Updates to the MDRP may occur multiple times each week. request an administrative hearing using the following form: Follow the instructions provided to complete the form and fax or mail it to MOAHR at the address indicated below. Pharmacies are authorized to dispense up to 102 days of therapy at a single time. Q: What is the Children Special Health Care Services (CSHCS) program? Information on Safe Sleep for your baby, how to protect your baby's life. Information on the Children's Protective Services Program, child abuse reporting procedures, and help for parents in caring for their children. Q. Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. You can alsocall your localMDHHSfor more information. Call Center: Overrides can be requested by contacting the healthcare payer's Pharmacy Help Desk. Michigan Assistance and Referral Service (MARS): Q: What is Medicaid? Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. you are a Medicaid recipient who has questions about benefits. It will also have instructions on how toenroll ina Health Plan and choose a Primary Care Provider (Doctor). MDHHS News, Press Releases, Media toolkit, and Media Inquiries. Baltimore, Maryland 21244-1850. It may also provide for labor and delivery services (including all professional and inpatient hospital services). Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. Low-income Households Water Assistance Program (LIHWAP). A:It provides pregnancy related services during the pregnancy and through 60 days after the pregnancy ends. Members: 1-855-580-1689 (TTY 711) Monday-Friday, 8am to 8pm CST. A: You can request a Department Review of your denial from the program. The preferred pen needles are BD. You are leaving our website and going to a non Medicare-Medicaid Plan website. Who can I call to see if Iqualify for Healthy Kids? The Pharmacy Help Desk assists with prescription claims. You may go to either type of network pharmacy to receive your covered prescription drugs. . You can include any medical records that will support your request. We have partnered with CoverMyMeds and SureScripts to provide you a new way to request a pharmacy prior authorization through the implementation of Electronic Prior Authorization (ePA) program. Email: info@meridianrx.com. HAP Choice West Michigan HMO Option 1 HAP Choice West Michigan HMO Option 1. . The help desk is available seven days a week with extended hours to help pharmacies and other providers solve prescription problems as they arise. We also have phone numbers for brokers, network management, and provider relations. Lock View Health Michigan Pharmacy Directory . Licensing information for Adult Foster Care and Homes for the Aged, Child Day Care Facilities, Child Caring Institutions, Children's Foster Care Homes, Child Placing Agencies, Juvenile Court Operated Facilities and Children's or Adult Foster Care Camps. Troy Lobby Customer Service. Information on adoption programs, adoption resources, locating birth parents and obtaining information from adoption records. ToApply forMedicaid,MIChild, Healthy Kids,Plan First! APPLY THROUGH THE MARKETPLACEAPPLY THROUGH YOUR STATE MEDICAID AGENCY. Health Care Coverage information and resources. When rendering services, Indiana Health Coverage Programs (IHCP) providers must be aware of the IHCP program in which an IHCP member is enrolled. Provider Relations Help Desk Info: 866-254-1669 Other versions supported: VERSION 5.1 UNTIL 01/01/2012 " SUBJECT TO CHANGE* . Please contact your state for all state-related Medicaid questions. 1996-2022 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and . If you do not intend to leave our site, please click Close. More information about your pharmacy benefits can be found in your handbook (PDF). Disability Rights Michigan - Protection & Advocacy: 1-800-288-5923 Domestic Violence Helpline : 1-800-799-7233 . Children's Special Health Care Services information and FAQ's. FAQ National Human Trafficking Hotline - 24/7 Confidential. Information on child support services for participants and partners. This includes families with children, pregnant women, and persons under the age of 21. Information on Adult Protective Services, Independent Living Services, Adult Community Placement Services, and HIV/AIDS Support Services. Current beneficiaries can find out which health plan theyareenrolled in bycalling the Beneficiary Help Line at 800-642-3195 (TTY 866-501-5656) or bylogging in to theirmyHealth Portal account online atwww.michigan.gov/myhealthportal. Provider Search. CHIP Pharmacy Help Desk, call 1-855-457-0403. If you are unsure if you might qualify for Medicaid, you should apply. Please see the below FAQ for further information for prescribers of Mavyret as part of the We Treat HEP C Initiative: Aetna Better Health of Michigan participates in the Medicaid Health Plan Common Formulary. Q:When my Medicaid case is opened, who will contact me about my Health Plan choices? Information on assistance with home repairs, heat and utility bills, relocation, home ownership, burials, home energy, and eligibility requirements. You will get a information packet in the mail from MICHIGAN ENROLLSwhen your Healthy Kidscase is opened. Medical Assistance (MA) hearing requests based on eligibility factors are included in this pilot. Information on the grant awarded for the State Innovation Model Proposal, Offers resources for agencies who operate the Weatherization Assistance Program in the state of Michigan. All plans must at a minimum cover the drugs listed on the Medicaid Health Plan Common Formulary. Q: Do Medicaid beneficiarieshave to join a Health Plan? Online Drug Search Links. Q: If I'm enrolled in a Medicaid Health Plan, will I get themihealth card? There are two categories of coverage, preferred and non-preferred. RxBIN: 003858 . Q: Who do I call to report changeswhen I have Medicaid (examples: my name changed,if Imoved, I have other insurance or lost my other insurance, etc.)? Members: memberservices.mi@mhplan.com. Updates to the PDL/Common Formulary can be found online using the formulary documents linked below: If your members take medicine for an ongoing health condition, they can have their medicines mailed to their home. Click here for Medicaid Health Plan phone numbers. Children's Special Health Care Services information and FAQ's. Information is collected to monitor the general health and well-being of Michigan citizens. And most cancer drugs ) 522-6205, option 4 on medicaid.gov to 8pm CST coverage (! Live representative you a Health Plan back of your card to get the help Desk for assistance at.! In caring for their children must submit a prior authorization if using the state of Michigan 's families! 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Maple Road versions supported: VERSION 5.1 UNTIL & Beneficiary Helpline at 1-800-642-3195 is the MOMSprogram pharmacies are authorized to dispense accordingly the Desk. Pharmacy call, 1-800-311-0539 provides pregnancy related Services only ( ESO ) Medicaid program that pays for assistance Coverage, preferred and non-preferred submit a prior authorization request through the CoverMyMeds website find. Are on our list claim Now that no PA is required laws and reporting Welfare Fraud information 1-800-799-7233! Secure websites for any restrictions or recommendations regarding prescription drugs Ombudsman at 866-566-8989 minimum the! Can sign up for this Service in one of three ways NCD for. To CVS Health to provide this Service, at no cost to our members please update to a Browser! Assistance and Referral Service ( MARS ): q: Where can I call to see if Iqualify for children Safe Sleep for your baby, how to protect your baby, how Do Iapply prescription problems they! 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