Addition of Pharmacy Explanation of Benefits for Claims Denied for Managed Care Beneficiaries

Effective July 1, 2021, an Explanation of Benefits (EOB) was added to NCTracks for pharmacy claims: EOB 2093 - SUBMIT CLAIM TO THE PHP FOR SERVICES INCLUDED IN THE MANAGED CARE PLAN.

This EOB is received when a pharmacy claim is denied due to the beneficiary being enrolled in Medicaid Managed Care. When a claim is denied for this cause, NCTracks will send the name of the Managed Care Plan that beneficiary is enrolled with, as well as information related to submitting pharmacy claims to that Managed Care Plan, on the pharmacy claim response transaction.

Pharmacy claim response transactions will include one of the following messages (as applicable) on the claim denied with edit 2093:

• AmeriHealth Caritas member: Bill to AMHC BIN 019595 PCN PRX00801 
• Carolina Complete member: Bill to CCHE BIN 004336 PCN MCAIDADV GRP RX5480  
• Healthy Blue member: Bill to BCBS BIN 020107 PCN NC GRP 8473 
• United Healthcare member: Bill to UNHC BIN 610494 PCN 4949 GRP ACUNC 
• WellCare member: Bill to WCHP BIN 004336 PCN MCAIDADV GRP RX8904  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M21193-R-2459