Medicare Compliance & Reimbursement

Part D plans need separate lines for providers and benes.

Pharmacists and providers can expect better access to Medicare prescription drug plans for their benefit and claim inquiries during the 2007 plan year. New communication standards could require Part D plans to maintain toll-free call centers and guarantee support to pharmacies and physicians, a Centers for Medicare & Medicaid Services official told plans during a recent Webcast.

The new standards would require each Part D plan to man a toll-free technical help line during network pharmacies' hours of operation. Under the new standards, plans must answer at least 80 percent of incoming calls within 30 seconds or less. Benes can direct inquiries about formulary exceptions and appeals to a separate toll-free line or a secure voicemail system. Plans must resolve health-threatening exceptions and appeals immediately--otherwise, they have one day for exception requests and three days for appeals requests.