As of Tuesday, May, 26, 2009 6:00 P.M. MDT, ACS will cease processing pharmacy claims for Wyoming EqualityCare. Goold Health Systems (GHS) will begin processing pharmacy claims on Thursday, May 28, 2009 using BIN 014293 and PCN WYOPOP.

·         On Wednesday, May 27, 2009 please direct any inquires to the Office of Pharmacy Services at 1-800-438-5785

·         Beginning Thursday, May 28, 2009 please contact Goold Health Systems at:

§  1-877-209-1264 for Point-of-Sale technical issues and

§  1-877-207-1126 for Prior Authorization Requests

Please note the following changes in contact information effective May 28, 2009.  Providers should continue to contact ACS with any issues regarding client eligibility.

GHS/POS Help Desk/Provider Relations Department, Cheyenne, WY:

Phone:  877-209-1264

FAX Only:  866-964-3472

Monday – Friday 8:00 AM – 5:00 PM MST

GHS Prior Authorization (PA)/Pharmacy Appeals/Clinical Call Center, Cheyenne, WY:

WY Pharmacy Prior Authorization Provider Hotline: 877-207-1126

Monday – Friday 8:00 AM – 5:00 PM MST

 FAX: 866-964-3472

The following updates/clarifications to Wyoming EqualityCare Policy will be effective as of May 28, 2009. All EqualityCare providers are stongly encouraged to thoroughly review the entire manual, as the following are only a small representation of the policy manual contents.

DISPENSE AS WRITTEN:

·         Due to the Mandatory Generic Program, Preferred Drug List (PDL) and Prior Authorization (PA) Process, DAW CODES are no longer necessary on prescription CLAIMS. DAW codes included in claims will be ignored by the POS system.

MAINTENANCE MEDICATIONS:

·         Only those drug classes listed in the Provider Manual will be allowed to be dispensed in a quantity of 90 days supply. In the past there have been instances of many drugs paying at day supplies of 90 or greater, and this will no longer be allowed. THIS POLICY WILL BE STRICTLY ENFORCED.

PRIOR AUTHORIZATION (PA) FORMS:

·         New PA forms are available at the back of the manual.

NPI/DEA NUMBER:

·         ALL pharmacy claims, including controlled substances, must be submitted with a pharmacy AND prescriber NPI.

·         Prescriber of controlled substances MUST also have a federal DEA number on file for the claim to pay. DEA numbers will not be allowed when submitting pharmacy claims and claims will reject if NPI numbers are not used.

OTC MEDICATIONS:

·         Are only covered if the manufacturer is providing rebates to CMS

·         Are covered only if listed in the Pharmacy Provider Manual

·         Are reimbursed at the same prices as legend drugs covered by Wyoming EqualityCare

·         Are not covered for clients residing in a nursing facility

Updated policies are detailed in the new Wyoming EqualityCare Pharmacy Provider Manual. The new manual with policy updates and payer sheets will be available on-line at http://www.wyequalitycare.org starting May 28, 2009.