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Alert: Magnolia Health NADAC & Specialty Reprocessing Notice

Date: 02/20/18

Alert: Magnolia Health Plan NADAC & Specialty Reprocessing Notice

Between Dates of Service from April 1, 2017 through February 2, 2018, Envolve Pharmacy Solutions experienced errors within their system that prevented successful processing of some claims which reimbursed using the National Average Drug Acquisition Cost (NADAC) prices. The following errors have been identified, and have all been corrected as of February 2, 2018.

1. The September 2017 price file used by Envolve Pharmacy Solutions did not contain an actual NADAC price for 4 NDCs. These 4 NDCs without a true NADAC will now pay at WAC/AAC/U&C (as outlined in SPA 17-0002 Pharmacy Reimbursement).

2. On 12/5/2017 a file processing error led to new NADAC pricing not being loaded, therefore claims reimbursed at historic NADAC pricing. This file has been updated. As of February 2, 2018 all claims are being paid at the updated NADAC prices. To ensure that this does not occur again, the system will be monitored.

3. A Specialty Pharmacy claims error was discovered on November 2nd2017, and corrected on November 9th 2017. This error, which was a result of GCNs matched to NDCs incorrectly, impacted 71 specialty claims causing incorrect reimbursement.

The claims impacted by these identified errors, which have not already been reversed and resubmitted by pharmacy providers, will be automatically reprocessed concurrently by Envolve Pharmacy Solutions February 21st-27th. Pharmacies affected by these errors would see the adjustments on their weekly Remittance Advice Statements provided on the February 28 pharmacy payment cycle.

Inquiries

Pharmacy providers can contact Accounts Payable at (559) 244-3748 or email EnvolveRxAP@envolvehealth.com for a list of their impacted claims.

Please contact the Envolve Pharmacy Solutions Help Desk at: (866) 9126285 ext 66409 for other questions.