GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Health Care Finance
Health Care Delivery Management Administration
October 6, 2020 (Revised Memo)
To: All District Medicaid Pharmacy Providers
Re: Continuity of Care for Beneficiaries in Managed Care and Provider Reimbursement
This transmittal is to inform you that as of October 1, 2020, Amerigroup District of Columbia
(Amerigroup) no longer participates in the District’s Medicaid Managed Care Program that includes the
DC Healthy Families Program (DCHFP), Immigrant Children’s Program (ICP) and DC Healthcare
Alliance (Alliance). On October 1, 2020, the DC Department of Health Care Finance (DHCF) entered
into new contracts with the following three MCOs:
• AmeriHealth Caritas DC
• MedStar Family Choice DC
• CareFirst Community Health Plan DC (formerly known as Trusted Health Plan)
The DHCF has expanded the managed care program to include former and qualifying fee-for-service
(FFS) Medicaid beneficiaries. Beginning October 1, 2020 through December 31, 2020, continuity of care
(COC) is priority and is particularly relevant as beneficiaries transition from one MCO to another or from
FFS Medicaid to managed care.
Effective immediately, DO NOT deny access to medications for any actively enrolled Medicaid
managed care enrollee who has either valid refills or new prescriptions for drugs or supplies, as
medically necessary. The DHCF guarantees that each MCO will retrospectively reimburse,
regardless of whether the DC Medicaid enrolled pharmacy is contracted with the MCO. Valid
authorizations and prescriptions are honored if issued prior to October 1, 2020.
How to Verify Beneficiary Eligibility for Medicaid Benefits and Services
It is important that you verify the new MCO assignment and eligibility status of each managed care
enrollee by requesting their new ID card which will contain the information (BIN, PCN and Group)
required to properly submit pharmacy (Rx) point of sale (POS) claims to the appropriate MCO Pharmacy
Benefit Manager (PBM) for reimbursement.
If the new ID card is unavailability at the time of service, eligibility status may be obtained through the
Interactive Voice Response (IVR) system by calling (202) 906-8319 (in District) or (866) 752-9231(outside
DC metro area).
• The IVR will prompt you to enter your provider number. This is the nine-digit number
assigned to you through the Medicaid program. The system will then prompt you to enter
the recipient number. This eight-digit code is listed on the patient’s Medical Assistance
Card.
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Health Care Finance
Health Care Delivery Management Administration
You may also contact each MCO and the respective Pharmacy Director for additional assistance. The
MCO/PBM Help Desk, MCO Enrollee Services, along with the pharmacy POS claims processing
information is provided on the resource document attached for your reference.
If you have any further questions, please contact the following at the DC Department of Health Care
Finance:
Charlene Fairfax, Senior Pharmacist
(202) 442-9076 or e-mail: charlene.[email protected]ov
Gidey Amare, Pharmacist
(202) 442-5952 or e-mail: gidey.[email protected]
Jonas Terry, Pharmacist
(202) 478-1415 or e-mail: jonas.[email protected] ; or
Magellan (Medicaid Fee for Service Pharmacy Benefit Manager)
1-800-273-4962.
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Health Care Finance
Health Care Delivery Management Administration
DC Medicaid Managed Care
Pharmacy Benefit Manager
Contact and Claims Processing Information Effective 10/01/2020
MCO
Pharmacy
Benefit Manager
Claims Processing
Information
Contact Information
AmeriHealth Caritas
Community Care
PerformRx
Rx BIN: 019595
Rx PCN: 06280000
Rx Grp:
(Not Required)
Medicaid Provider
Services (PBM)
1 (888) 602-3741
Medicaid Enrollee
Services
1 (888) 452-3647
Alliance Provider
Services
1 (888) 987-5821
Alliance Enrollee
Services
1 (888) 987-5806
CareFirst Blue Cross
Blue Shield
Community Health
Plan
Abarca
RX BIN: 610674
Rx PCN: ABARCA
Rx Grp: THPDC
Help Desk
1 (866) 287-6156
Enrollee Service
(855) 326-4831 or
(202) 821-1100
MedStar Family
Choice
CVS/Caremark
Rx BIN: 004336
Rx PCN:
MCAIDADV
Rx Grp: RX0610
PBM Help Desk:
1 (855) 798-4244
(Preferred)
1 (800) 966- 5772
Enrollee Services:
1 (888) 404-3549