TennCare has contracted with Mercer Government Human Services Consulting to conduct a professional cost of dispensing survey and a survey of acquisition cost data. Both surveys will begin on April 3. Mercer will conduct a technical online seminar on March 20 at 10am CT to discuss both surveys and answer provider questions. Join the online seminar at this link with passcode 030511.
Also in Tennessee, the recent TennCare issue regarding AAAC rate updates has been resolved. Please review this document and contact tenncare_inquiry@optum.com with any questions.
Finally, to help TennCare prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses are on the Appropriate Diagnosis for PA Bypass document. Prescribers are encouraged to include the applicable diagnosis code on written prescriptions for inclusion on the electronic pharmacy claim. The submitted claim should include a Diagnosis Code Qualifier (Field # 492- WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). Note: A list of the preferred agents and the clinical criteria can also be found at www.optumrx.com/oe_tenncare/landing.
Please contact OptumRx Provider Liaison Ginger Stoves (ginger.stoves@optum.com) if you have additional questions. Ginger is the primary contact for Middle Tennessee, and the temporary primary contact for East and West Tennessee.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.