Missouri Rx Plan - Pharmacist FAQs
- What number do I call for questions with processing MORx claims?
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Contact Pharmacy Administration at (573) 751-6963.
- What is the Missouri Rx Plan (MORx) BIN/PCN? Where should I send the Medicare Part D coordination of benefits (COB) claims?
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Use the following BIN/PCN when submitting claims to MORx: 004047/P021011511
- Where should I send Medicare Part D excluded drug claims for participants?
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Use the following BIN/PCN when submitting excluded drug claims for participants: 004047/P021011511
- Where should I send Medicare Part D excluded drug claims for MO HealthNet only participants?
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Use the following BIN/PCN when submitting excluded drug claims for MO HealthNet only participants: 004047/43-1754897
- What is MORx's group ID?
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A group ID number is not required. BIN/PCN and member ID are the only information needed to process a claim.
- What do I use for the member's MORx ID number?
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The member's Medicare Beneficiary Identifier (MBI) is their MORx member ID number. The MBI is printed on their Medicare health insurance card.
- What medications are covered?
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MORx pays toward the out-of-pocket cost of the formulary of the Medicare Part D plan. If the member’s Medicare Part D plan does not cover a drug, MORx will not cover it. Part D excluded drugs will continue to be covered. MORx does not cover compound drugs.
- Will specific Part D plan information appear for participants the same way that a primary plan will show for a fee for service participant when pharmacies are billing MO HealthNet?
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No, but the Part D plan information will be available to the pharmacies through an E-1 transaction.
- How can people enroll in MORx?
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Individuals receiving Medicare and a MO HealthNet benefit are eligible for MORx coverage and automatically enrolled in the program.
- Will MORx work with mail-order pharmacies?
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No. MORx does not work with mail-order pharmacies. MORx will provide wrap-around benefits for covered prescriptions purchased at any non-mail-order pharmacy that is contracted with MO HealthNet and with the member's Part D plan.
- Will MORx process paper claims?
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MORx only accepts claims that are submitted electronically and cannot accept paper claims submissions.
- Will the MORx benefit apply to the purchase of a 90-day supply of medication?
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No. The MORx benefit will not cover a 90-day supply of medication. The MORx benefit will cover up to a 31-day supply of each prescription at a time.
- Are there Part D plans set up specifically for Long Term Care (LTC) patients to ensure LTC pharmacies will be reimbursed for bubble packaging, delivery service, emergency boxes and drug disposition?
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No. All LTC pharmacies in a region need to negotiate terms and conditions with as many plans as possible or risk losing business to another more competitive LTC pharmacy. Part D plans are encouraged to work with all LTC pharmacies so that all of the Part D plan enrollees can get prescriptions.
- If a participant has Medicare Parts A and B and is eligible for MO HealthNet under Blind Pension (ME Code 02), must they enroll in a Medicare Part D plan? Will MO HealthNet continue paying for their prescription drugs?
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Blind Pension participants (ME Code 02) must enroll in a Part D plan. MO HealthNet will continue paying for their prescription drugs. ME codes exempt from the Part D requirement are 08, 09, 57, 59, 64 and 65.
- Will co-pays need to be collected for Medicare Part D?
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Medicare Part D co-pays are real co-pays. Unlike MO HealthNet co-pays, providers may refuse service if a patient does not pay their Medicare Part D co-pay.