Medicare Prescription Payment Plans

The Medicare Prescription Payment Plan is a new payment option in the prescription
drug law that helps you patients manage out-of-pocket Medicare Part D drug costs
by spreading them across the calendar year. 

You will receive notifications regarding a patient’s enrollment when you transmit the
claim.

Code 56 – Patient is not signed up. Medicare wants you to provide the patient information.
Code 57 – Patient is enrolled. Secondary billing information will be provided in the claim.
Code 58 – Patient is NOT enrolled. Do not provide information.

Code 57 – Patient has a MPPP Plan

We will warn you at the bottom of the screen that the patient has a MPPP plan. 

Type OK and hit Return to continue.

On the first claims transmission message, we will show you again that the patient has a MPPP plan.

On the second claims transmission message, we will show you where to send the secondary
claim. If this insurance is already in your insurance file, you can hit 1 and Enter to add the
insurance to the patient. *If you do not see the Add1 option on your screen, call us to have
it added.*

Code 56 – Not Enrolled but Patient is Eligible for MPPP

We will display the following claims message if the patient is not enrolled for MPPP.

Medicare wants you to provide the following handouts to the patient.

English

Spanish

Code 58 – Not Enrolled or Eligible for MPPP

We will display the following claims message if the patient is not enrolled or eligible for MPPP.

Reporting

We have added a switch to the F7 Reports to look for any prescription that came back
with a Code 57 and was NOT transmitted to a MPPP plan. On line 9, put switch /HM3P

Labels

We can also print a message on your labels for Codes 56 and 57. The code 57 message will
only print if you did not send the eligible claim to a MPPP plan.

Code 56 – Provide Likely to Benefit Notice

Code 57 – Did NOT bill MPPP plan

Please call to have these messages added to your label