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Plan Name/Group Name: MI01/MIMEDICAID BIN:009737 PCN: P008009737 Processor: Processor/Fiscal Intermediary Effective as of: 01/01/2012 NCPDP Telecommunication Standard Version/Release #: D.0 NCPDP Data Dictionary Version Date: 10/2017 NCPDP External Code List Version Date: 10/2017 You can also directly call Express Scripts Pharmacy Help Desk at 1.800.922.1557 or visit their Pharmacist Resource Center. The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2021 Medicare Part D plan sponsor. BIN/PCN/Group Numbers for ACOs, MCOs and PCC Plan The three tables below shows the correct combinations effective March 1, 2018, for pharmacies to use when submitting MassHealth ACO/MCO/FFS pharmacy claims. PDF New ID cards are being distributed for 2022 See below for important To obtain an IIN, please contact the American National Standards Institute (ANSI) at www.ansi.org. 0000000016 00000 n 0000008161 00000 n Rx BIN#: 400023 Rx PCN#: 0020050403 Issuer#: (80840) CMS#:H3330-037-000 Plan Name Network: VIP Prime Comprehensive Dental X327934200116X 3 2 7 9 3 4 2 0 0 1 1 6 MEMBERS AND PROVIDERS: Network providers must provide or arrange nonemergency care. CDPHP (800) 388-2994. BIN Number Additional Information Required for Pharmacy Processing; Affinity Health Plan (866) 247-5678; CVS Caremark (800) 364-6331 . DownloadtheNCPDP Payer Sheet Template, more information is available by selecting Resource Topic - "HIPAA". NCPDP - NCPDP Processor ID (BIN) 11-A1 BIN Number See BIN/PCN table, above M 12-A2 Version Release Number D=Version D.0 M 13-A3 Transaction Code B1=Billing M 14-A4 Processor Control Number As indicated above M 19-A9 Transaction Count 1=One Occurrence 2=Two Occurrences 3=Three Occurrences 4=Four Occurrences M (BIN 6156 only allows TRANS COUNT = 1). If you forget if you need a group number or not, use the third party inquiry. 0000004799 00000 n Please renew your membership to login. 0000007096 00000 n To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). 0000009323 00000 n WQqiT/ Y* T/q)~Z? Sign Up To Receive Emails For Events, News & General NCPDP Information. Administrator, BIN, PCN, Group, and telephone number Specialty Pharmacy name and telephone number Website address for pharmacy information Buckeye Health Plan RxAdvance . RX Group: UHEALTH . }|a3M3J=/`zy[X >]!/c 5'{ Xri endstream endobj 73 0 obj 336 endobj 47 0 obj << /Type /Page /Parent 42 0 R /Resources 48 0 R /Contents 56 0 R /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 >> endobj 48 0 obj << /ProcSet [ /PDF /Text /ImageC ] /Font << /TT2 53 0 R /TT4 52 0 R /TT6 51 0 R /TT8 57 0 R /TT10 60 0 R /TT12 61 0 R >> /XObject << /Im1 63 0 R >> /ExtGState << /GS1 66 0 R >> /ColorSpace << /Cs6 55 0 R >> >> endobj 49 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 0 /Descent -216 /Flags 34 /FontBBox [ -568 -307 2000 1007 ] /FontName /FHGHLD+TimesNewRoman /ItalicAngle 0 /StemV 0 /FontFile2 67 0 R >> endobj 50 0 obj << /Type /FontDescriptor /Ascent 891 /CapHeight 0 /Descent -216 /Flags 34 /FontBBox [ -558 -307 2000 1026 ] /FontName /FHGHND+TimesNewRoman,Bold /ItalicAngle 0 /StemV 133 /FontFile2 68 0 R >> endobj 51 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 32 /Widths [ 250 ] /Encoding /WinAnsiEncoding /BaseFont /FHGHND+TimesNewRoman,Bold /FontDescriptor 50 0 R >> endobj 52 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 49 /Widths [ 250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 500 ] /Encoding /WinAnsiEncoding /BaseFont /FHGHLD+TimesNewRoman /FontDescriptor 49 0 R >> endobj 53 0 obj << /Type /Font /Subtype /TrueType /FirstChar 32 /LastChar 119 /Widths [ 352 0 0 0 0 0 0 0 0 0 0 0 364 0 364 454 636 636 0 0 636 0 0 636 0 0 0 0 0 0 0 0 0 0 0 0 771 0 575 0 751 421 455 0 557 843 748 0 603 0 0 684 0 0 0 0 0 0 0 0 0 0 0 0 0 601 0 521 623 596 0 0 633 274 0 592 274 973 633 607 623 0 427 521 394 633 592 818 ] /Encoding /WinAnsiEncoding /BaseFont /FHGHKH+Verdana /FontDescriptor 54 0 R >> endobj 54 0 obj << /Type /FontDescriptor /Ascent 1005 /CapHeight 0 /Descent -209 /Flags 32 /FontBBox [ -50 -207 1447 1000 ] /FontName /FHGHKH+Verdana /ItalicAngle 0 /StemV 96 /FontFile2 65 0 R >> endobj 55 0 obj [ /ICCBased 64 0 R ] endobj 56 0 obj << /Length 1929 /Filter /FlateDecode >> stream