Pharmacy Services
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Pharmacy Services Call Center *
MC-Rx's Pharmacy Services Call Center is staffed with knowledgeable, bilingual pharmacists and pharmacy technicians to effectively assist you during your call. Our Pharmacy Services Call Center is equipped with state-of-the-art telecommunications systems that provide all the necessary features to maintain our customer service operations performing at optimum capacity 24/7/365. Our Call Center Support Representatives can address questions regarding a member's benefit plan, including information about eligibility, copays, deductibles or co-insurance, and alert message interpretation, as well as other details required for claims management.
Pharmacy Services Call Center: 24/7/365
Toll-Free Numbers: 1-888-311-6001 / 1-866-411-6001
TTY Numbers: 711
Fax Number: 1-787-653-2814
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Prior Authorization Call Center *
Receive support and assistance when processing a prescription for a medication requiring authorization prior to dispensing. Designed to offer personalized services, well-staffed with bilingual representatives, equipped with the latest technologies, and available 24/7/365, our Prior Authorization Call Center provides exceptional service. Operations are continuously monitored and evaluated to maintain the quality of standards that our providers expect and deserve.
Prior Authorization Call Center: 24/7/365
Toll-Free Numbers: 711
TTY Number: 1-800-850-6682
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Pharmacy Network *
MC-Rx provides its Pharmacy Network members with administrative support to ensure compliance with applicable policies, regulations, laws, and contractual agreements. This is a continuous, collaborative process that promotes sound business practices and ensures the utmost quality service standards for our clients’ members.
Our Pharmacy Network Support Staff will assist you with any questions regarding Pharmacy Network contracts, requisites for becoming a member of the Pharmacy Network (Credentialing), and requisites for renewing Pharmacy Network membership (Re-credentialing), among other Pharmacy Network needs.
Pharmacy Network: Monday - Friday, 8:00am – 5:00pm
Telephone Number: 1-787-286-6032, Ext. 3147
TTY Number: 711
Fax Number: 1-787-653-2856
Email: PharmacyContracting@mc-rx.com
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Pharmacy Provider Manuals
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Pharmacy Auditing Program *
The Pharmacy Auditing Program is a unique, encompassing program and the key component for the adequate management and utilization of prescribed medications:
- Ensures compliance with applicable laws and regulations
- Ensures compliance with contractual terms between MC-Rx and participating pharmacies
- Identifies, avoids, and prevents fraud, waste, and abuse
- Ensures the validity and accuracy of the claims processed and invoiced to our customers and to CMS
- Educates participating pharmacies on the submission of electronic claims and proper documentation
- Pharmacy Audit Guidelines
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Pharmacy Forms
For your convenience, you may fill out most of these forms online.
Download Acrobat Reader here, fill out the form, save it on your device/computer, and submit it to MC-Rx following the instructions on the form.
- Electronic Funds Transfer (EFT) Request
- Guidelines for Adequate Medication Processing & Dispensing
- Notification CMS 10147
- Pharmacy Profile Update
- Prior Authorization Request Form
- Request to Dispute a Claim - Report discrepancies regarding an un-paid prescription or particular adjudication situations
- Request to Reverse a Pharmacy Claim
- Request for Reimbursement
- Universal Claim Form (UCF)
- PRX Maryland Generic Pricing Appeal Form MD GPA 2021a
- MC-Rx MD MC-Rx GPA 2021
- Disclosure Statement
- TN Standard Pharmacy Reimbursement Form for Actual Cost Appeals
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Fraud, Waste, and Abuse (FWA) *
MC-Rx is committed to prevent, reduce, and control incidences of fraud, waste, and abuse in accordance with federal and local laws. Our goal is to guarantee that all MPD pharmacy providers comply with instructions for prescriptions billing and dispatch, as established by the Centers for Medicare & Medicaid Services (CMS).
CMS has removed its own published Medicare Advantage and Part D General Compliance and FWA training modules from its website; however, compliance training is still required, and MC-Rx remains obligated to conduct routine monitoring, auditing, and oversight of their FDRs. Therefore, the Participating Pharmacy Providers must continue to conduct General Compliance and Fraud, Waste, and Abuse training and provide MC-Rx with an annual attestation to that effect. For your benefit, we have developed a training course tailored for pharmacies that serve Medicare Part D beneficiaries.
Who must complete the FWA training?
Every person that participates in the administration or delivery of Medicare Part D benefits must complete this training.
When must the training be completed?
No later than December 31st of each year.
- FWA Training Course – Use our customized training course to educate your staff
- FWA Attestation Forms – Once training is completed, print and fill out the Training Attestation Forms and send them to MC-Rx.
Email: pharmacycontracting@mc-rx.com
Fax: 1-787-653-2856
Mail: MC-Rx, Pharmacy Services Department, P.O. Box 4908, Caguas, Puerto Rico 00726
TTY Number: 711
For more information on FWA training requirements, contact MC-Rx’s Pharmacy Services Department at 787-286-6032, Ext. 3147 or 3122.
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Pricing Review Processes
Actual Cost Appeal (TN)
ProCare Rx accepts appeals from pharmacies asserting that they have not received reimbursement for at least actual cost for all prescription drugs, drug products, and devices paid for by ProCare Rx.
A pharmacy must submit its Actual Cost Appeal to ProCare Rx within seven (7) business days of its submission of the initial claim for reimbursement.
- ProCare Rx has seven (7) business days from the date it receives all required documentation for processing an Actual Cost Appeal to make a final decision to grant or deny the pharmacy’s appeal.
- If a pharmacy decides to appeal ProCare Rx’s denial of its Actual Cost Appeal to the TN Insurance Commissioner, the pharmacy must submit their appeal within thirty (30) days of receipt of ProCare’s appeal denial notice.
- Tennessee Pharmacy Actual Cost Appeals Policy
- TN Department of Commerce & Insurance Standard Pharmacy Reimbursment Appeal Form
- Please address all questions regarding this process to reimbursement@procarerx.com
MPD MAC List Application – Review the cost of a prescription drug included in the Medicare MAC List. Search by name and/or date.
MAC Price Review Request Application – Access MC-Rx’s Price Review Request Application to ensure an agile and effective management of your request for the revision of a generic drug price.
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Pharmacy Communications *
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Pharmacy PA Status Tool *
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Complaints *
Pharmacy member complaints or grievances are a means of continually improving the quality of our services.
If you have a complaint regarding our services, please complete the Complaints Form.
All complaints will be handled in a timely manner.
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Payer Sheets
* Puerto Rico
