IMPORTANT PHARMACY CLAIMS PROCESSING CHANGE FOR MASSACHUSETTS HDAP AND TBDAP
CRI is transitioning from its current model of pharmacy claims processing and payment to one utilizing an outside Pharmacy Benefits Manager (PBM) for all pharmacy claims adjudication for the Massachusetts HDAP and TBDAP programs. Currently, CRI processes claims internally for insured clients (i.e. co-pay claims) and externally through CVS Caremark for uninsured clients (i.e. full-pay claims). Beginning July 1, 2022 at 12:00 am EST, both full-pay and co-pay claims for eligible clients of HDAP and TBDAP will be processed by CRI’s new PBM vendor, Magellan Rx Management LLC (“MRx”) using its real-time adjudication system.
Information regarding billing instructions, payer specifications, and fee schedules will be sent to pharmacies directly by MRx in the coming weeks. For questions, please email billing@crine.org or call CRI’s main line at 617-502-1700.
