Medicare Pharmacy Information for Providers

Common Medicare Part D Forms 

• Hospice — Medicare Part D (PDF)
• Medicare Standard Form (PDF)  

Medicare High Risk Medications 

MVP has created a high-risk medication report by prescriber for the most frequently prescribed medications that may cause harm in the elderly population. The report contains the Member's name, medication prescribed, quantity dispensed, date of last fill and the pharmacy where the medication was filled. The goal of the report is to make the prescriber aware of these medications and offer potential alternatives (if clinically appropriate in the elderly population). 

Download the MVP Medicare High Risk Medications Report.

Online Billing for Part D Vaccines and Administration with TransactRx 

Providers now have an online option for processing Medicare Part D vaccine claims electronically. TransactRx Part D Vaccine Manager, a product of Dispensing Solutions Inc., provides physicians with real time claims processing for in-office administered vaccines. This new online resource helps to reduce the current challenges in providing Medicare Part D vaccines and vaccine administration reimbursement to our Members.

Online Billing Enrollment 

Enrollment in TransactRx is available at no cost to physicians or patients. After completing a simple one-time online enrollment process on the TransactRx Website physician offices can: 

• Verify Members’ eligibility and benefits in real-time 
• Advise Members of their appropriate out-of-pocket expense 
• Submit vaccine claims electronically 
• Receive reimbursement information in real-time  

Physicians should select an authorized staff member who is most likely to be the primary user of the system to enroll the practice. This person should be prepared to provide the following information about the practice: 

1. Tax identification number 
2. National provider identifier(s) (NPI) 
3. Medicare ID number 
4. Drug Enforcement Administration (DEA) number 
5. State medical license number 

When using TransactRx Part D Vaccine Manager to file a Medicare Part D vaccine claim, physicians will be reimbursed according to MVP Health Care’s reimbursement schedule, less the Member’s co-pay. Note: The Member’s co-pay is not always a flat dollar amount. It could be a percentage co-pay or even full price depending on where the Member is in their Part D pharmacy benefit (for example: if a Member is in their deductible phase or coverage gap, they could be responsible for 100% of the cost for the vaccine and its administration). TransactRx cannot be used to bill the administration and cost of Medicare Part B covered vaccines (e.g., influenza vaccine, pneumococcal vaccine, or Hepatitis B vaccine for high or intermediate risk individuals).  

Questions?

For questions related to enrollment and claims processing, call Dispensing Solutions’ customer support center at 1-866-522-3386 (EDVM). You can also contact the Professional Relations Service Center at 1-585-325-3114 or 1-800-684-9286 , or email us. 

Online Billing Option for Part D Vaccines and Administration 

eDispense Part D Vaccine Manager, a product of Dispensing Solutions Inc., is a web portal that provides physicians with real-time claims processing for in-office administered vaccines. This online resource helps to reduce the current challenges in providing Medicare Part D vaccines and vaccine administration reimbursement to our Members.

Additional Information 

For a list of additional links, drug coverage information, CVS Caremark® details, and more, visit our Medicare Member Prescription Drug Coverage page or our Provider Formulary page.  

For more pharmacy-related information for Providers, visit our Provider Pharmacy page.