[Kristin]

We have a patient who has Regence primary and Medicare secondary. Regence will not process his immunosuppresive drugs stating they must go through pharmacy benefits. I am trying to get them to process the claim through medical benefits so I can submit the co-insurances to Medicare part B. Has anyone had any experience with this? Do you just submit them through pharmacy, and if so, do you then submit them to Medicare to be processed under part B?

[DMEisgoodfun]

Hey Kristin, I had this exact situation when I was working there - probably the same client. Call Regence and explain MSP and they need to process as Part B. They were really good about fixing it, but the claims usually first denied and required a follow-up phone call. Once you get someone who understands how to process, ask if you can call them direct if it denies again.

[Kristin]

Thanks, i'm sure you ran into this situation, i've had it with several patients. On this one in particular i've had to work with our Regence provider rep. before anything got done!