Medicaid and Medicare Prescription Drug Information

Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. Two plans that may cover prescriptions are Medicare Part B and Medicare Part D.

Member Information

If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.

Provider Information

Medicare Part B and Part D drugs will not be covered by the Kentucky Department for Medicaid Services. These claims will deny with NCPDP Error Code 41 and the supplemental message of "Submit bill to other processor or primary payer" with the additional message "Bill Medicare Part D; Other payer not cost avoided."

Regarding billing: contact DXC at 800-807-1232 or visit the website.

Regarding members: contact 800-635-2570.

Regarding Provider Enrollment: contact Provider Enrollment at 877-838-5085 or visit this website.

Regarding Archived Medicare Part B Information

The Medicare Point of Sale edit was added on March 1, 2003 to the Medicaid program claims processing system for pharmacy services.  The edit ensures that Medicare covered drugs are not paid by Medicaid.  Those services, which Kentucky Medicaid recognizes as routinely covered by Medicare, will deny if submitted first to Medicaid.