Adjudication Changes
for Dual Eligible Clients

July 18, 2014

On July 30, 2014, the Vendor Drug Program will update the Fee-For-Service (FFS) Medicaid pharmacy claim processing system for clients eligible for Medicare Part D.  These changes may result in an increase in the number of Medicare Part D rejections.  Pharmacy staff should refer to the announcement (PDF) highlighting the changes and contact the Vendor Drug Program for more information.

Limited Income Newly Eligible Transition (LI-NET)

The Centers for Medicare & Medicaid Services (CMS) created the Limited Income Newly Eligible Transition (LI-NET) program to provide temporary Part D prescription drug coverage for low income Medicare beneficiaries eligible for both Medicare and Medicaid but not already enrolled in a Medicare drug plan.  The program is administered for Medicare by Humana.  To learn more:

Facilitated Enrollment

The point-of-sale facilitated enrollment process ensures that dual-eligible clients who are not yet enrolled in a Medicare prescription drug plan (PDP) are still able to obtain prescription drug coverage when evidence of Medicare and Medicaid eligibility is presented at the pharmacy.  Pharmacy staff can submit an eligibility verification (E1) transaction to Relay Health to identify whether the client is already enrolled in a PDP.