CONFIDENTIAL AND PROPRIETARY
If you believe a patient has been retroactively assigned an institutionalized Low Income Cost Subsidy (LICS) status from CMS, we recommend you proceed to reverse and resubmit the claims for the member.
If you feel a patient’s LICS level has not been updated, LTC pharmacies are strongly encouraged to submit the Best Available Evidence, as defined in CMS guidelines, to WHI or the respective Part D plan sponsor, per CMS guidelines, as quickly as possible, to request the member’s LICS status be changed to institutionalized. WHI will reconcile payment amounts at the end of the year.
Cost sharing overpayments resulting from retroactive LICS changes will be returned to the patient unless the pharmacy has signed the LTC Certification indicating that the copays have been waived by the pharmacy.
If you have any questions, please feel free to contact the Provider Relations Department at Provider.Relations@walgreens.com or the applicable plan sponsor, as appropriate.
LTC Rebate Reporting
To the extent that rebate reporting is required by CMS, the pharmacy will cooperate with Walgreens Health Initiatives and the plan sponsor in providing the rebate information necessary for plan sponsor to meet its obligations under the Medicare Part D regulations and/or CMS guidance.
Medicare Part D Vaccines
Effective 01/01/2008, certain Vaccines and their administration moved from Part B coverage to Part D coverage. Pharmacies or other medical providers will be required to bill Part D plans (through the Walgreens Health Initiatives) for the drug, the administration (professional charge), or both.
WHI requires a special Addendum be signed for providers that administer this vaccine in addition to the regular Pharmacy Network Agreement to receive reimbursement for the administration.
If you wish to be contracted to administer these vaccines, contact our Provider Relations department via email at Provider.Relations@walgreens.com. Remember, if you are part of a chain or buying group, you will need to work through your corporate office.
Submitting claims POS (Point of Sale):
To submit claims for the DRUG only, no changes are required.
Walgreens Health Initiatives – Pharmacy Manual