The new Pharmacy Benefits Management System (PBMS) will go live on Sunday, March 26th, at 5:00 pm CDT
All pharmacy claims must be submitted with new Bank Identification Number/Processor Control Number (BIN/PCN) in order to pay.
Effective Sunday, March 26th at 5:00 pm CDT:
The new POS system will be using the NCPDP COB 3 scenario
See the payor sheets below for additional changes required for submission of NCPDP D.0 claim transactions
Specific programming instructions for submittal of NCPDP D.0 format transactions are contained in each payor sheet. Pharmacies are encouraged to pay particular attention to the Coordination of Benefits/Other Payments Segment Questions section of the payor sheet.
Illinois Medicaid NCPDP Version D.0 Payor Sheet (PDF)
Illinois Medicaid NCPDP Version E1 Payor Sheet (PDF)
In addition, with the new PBMS, pharmacies may also submit claims electronically via the Internet through the Illinois Rx Provider Portal using Direct Data Entry (DDE). Users may submit claims, and receive a real-time response to claims submission. Registration to the ILLINOIS Rx Provider Portal is available free of charge to pharmacies registered with IMPACT. Actual implementation being Sunday, March 26, 2017 at 5:00 pm CDT.
Note: The DDE system may be used to submit a claim or request a prior approval, but does not have the capability to reverse a claim.
For additional questions or assistance regarding the Payor Sheet, or submission of claims via DDE, please contact a Bureau of Professional and Ancillary Services Pharmacy Billing Consultant at 877-782-5565.