Express Scripts has implemented emergency procedures for Refill-Too-Soon edits due to Hurricane Sandy. Emergency procedures will be in effect until November 26, 2012.
Due to Hurricane Sandy, ESI is implementing Emergency Refill Too Soon Procedures in:
Virginia, District of Columbia, Maryland, Delaware, Pennsylvania, New Jersey, New York, Connecticut, Massachusetts, Rhode Island, the West Virginia counties of: Jefferson, Brooke, Marshall, Ohio, Hancock, Wetzel, Barbour, Lewis, Upshur, Nicholas, Webster, Pocahontas, Randolph, Harrison, Tucker, Greenbrier, Preston, Doddridge, Gilmer, Braxton, Ritchie, Tyler, Taylor, Marion, Monongalia, Grant, Mineral, Hardy, Pendleton and the North Carolina counties of: Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Cumberland, Currituck, Dare, Duplin, Edgecombe, Gates, Greene, Halifax, Harnett, Hertford, Hoke, Hyde, Johnston, Jones, Lenoir, Martin, Nash, New Hanover, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Robeson, Sampson, Tyrrell, Washington, Wayne.
This is effective October 27, 2012 and expires on November 26, 2012.
Effective immediately, if a patient from the disaster areas attempts to fill a prescription for lost or damaged medication resulting from the disaster, and the claim rejects with a Reject 79 "Refill Too Soon," the pharmacy should enter override code 91100000001 in NCPDP vD.0 field 462-EV "Prior Auth Number Submitted."
This override code should be used to process claims only for affected members in the designated disaster areas thru November 26, 2012.
BRS members may also contact Grand Lodge at (540) 622-6522 for information.