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Limited Income NET Program
| Note: The program previously known as the WellPoint Point-of-Sale Facilitated Enrollment (POS FE) process has been redesigned by CMS. Effective 1/1/2010, it will become the Limited Income NET Program, administered by Humana. |
The Limited Income NET (or LI NET) Program is designed to eliminate any gaps in coverage for low-income individuals transitioning to Medicare Part D drug coverage.
Immediate need prescription drug coverage: The LI NET Program will ensure that individuals with Medicare's low-income subsidy (LIS), or "extra help," who are not yet enrolled in a Part-D prescription drug plan are still able to obtain immediate prescription drug coverage.
This includes:
- Beneficiaries with Medicare and Medicaid, also known as "dual eligibles;" and
- Those with Medicare who also receive Medicare's low-income subsidy.
Retroactive coverage: The LI NET Program will also provide retroactive coverage for new dual eligibles. Medicare automatically enrolls these individuals into LI NET with an effective date back to the start of their full dual status, or their last enrollment in a Medicare Part-D plan. These individuals are covered by LI NET temporarily while Medicare enrolls them in a standard Medicare Part D plan for the future.
Billing Procedures
Pharmacy providers will need to bill the beneficiary-specific 4Rx data for these individuals. The 4Rx data are printed at the top of the beneficiary's confirmation letter from LI NET (if available). They may also be obtained through a query to Medicare's online eligibility/enrollment query system. A query will return the 4Rx data; if a phone number for contract "X0001" is returned, the beneficiary is enrolled but the 4Rx data are not yet available on Medicare's system. In this case, use the following:
- BIN = 610649
- PCN = 05440000
- Cardholder ID = Beneficiary HICN
- Group ID may be left blank
Pharmacists should continue to perform an E1 query on these individuals on a monthly basis because they will be enrolled by CMS into a regular Part D plan within two months.
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