Explore the differences between Original Medicare and Medicare Advantage so you can choose the best Medicare plan for you.
LI NET—Pharmacy resources
Humana is committed to providing pharmacists with tools and resources to facilitate a beneficiary’s enrollment into the LI NET program.
LI NET is a Medicare program that provides immediate prescription coverage for Medicare beneficiaries who qualify for Medicaid or “Extra Help” and have no prescription drug coverage.
Enrollment in LI NET is temporary, usually for 1 to 2 months. This provides the beneficiary time to choose a Medicare Part D prescription drug plan that best fits their needs. If the beneficiary does not select a plan within this timeframe, Medicare will enroll the beneficiary into a benchmark plan. Coverage for out-of-pocket expenses during eligible periods (retroactive coverage) is also available by submitting a direct member reimbursement form.
LI NET eligibility
Qualifying individuals must:
- Not be enrolled in any other Medicare Part D prescription drug plan
- Have either Medicare and Medicaid or Medicare and “Extra Help”
4 steps for pharmacy providers
Note: Some claims may not require all 4 steps.
Request individual’s Medicare (red, white and blue) ID card
If the patient has a Medicare Part D plan ID card or a Medicare Part D plan letter with 4Rx data, submit claims to the Part D payer. If not, go to step 2.
Submit an E1 transaction to Medicare’s online eligibility/enrollment system
Plan enrollment data is available for 90 days before the query. If you’re not sure how to submit an E1 query, please contact your software vendor.
If the E1 query returns:
- BIN/PCN—Submit the claim to the plan indicated
- Contract ID number and help desk number—Contact the plan for 4Rx data
If the E1 query does not return plan enrollment data, go to Step 3.
Verify eligibility for Medicare and either Medicaid or “Extra Help”
You can verify eligibility with a:
- Medicaid ID card
- Copy of current Medicaid award letter with effective dates
- State eligibility verification system query (interactive voice response, online)
- Notice from Medicare or SSA awarding “Extra Help”
If the individual cannot provide evidence of current eligibility for Medicare and Medicaid or “Extra Help,” don’t submit the claim. Instead, refer the patient to his or her State Health Insurance Assistance Program (SHIP). If the patient is eligible for LI NET, go to step 4.
Submit a claim
You have 2 ways to
- Use the 4Rx data in the patient’s enrollment confirmation letter, or use the Medicare claim number (on the red, white and blue Medicare card).
- If the patient does not have a letter, use the entire Medicare claim number (on the red, white and blue Medicare card) and the 4Rx data below:
BIN: 015599
PCN: 005440000
Group ID: May be left blank
Cardholder ID: Medicare claim number (include letters)
Optional field:
Patient ID: Medicaid ID or Social Security number
Helpful LI NET resources for pharmacists
Eligibility requirements of the LI NET program include:
- Medicare and Part D eligibility
- Eligible for “Extra Help,” including any of the following:
- Full-benefit dual-eligible beneficiaries: those with Medicare and full Medicaid benefits
- SSI-only beneficiaries: those with Medicare who receive Supplemental Security Income (SSI) but do not have Medicaid
- Partial-benefit dual-eligible beneficiaries: those with Medicare who qualify for Medicare Savings Programs (MSP) but not full Medicaid, i.e., QMB Only, SLMB Only and QI
- “Extra Help” applicants: those who have applied for, and have been awarded, “Extra Help” through SSA or their state
- Have no other prescription coverage, including:
- Part D plan coverage
- Retiree drug subsidy (RDS) plan
- VA coverage
- Not enrolled in a Part C plan, which does not allow concomitant enrollment in a Part D plan
- Not opted out of auto-enrollment
- Have a permanent address in the 50 states or DC