FPH Billing Instructions for Medmark Injectables
As you were notified in the April issue of the Bulletin, Medmark Inc., a Pittsburgh-based full
service specialty pharmacy, has been selected by First Priority Health as the exclusive specialty
pharmacy provider for this voluntary program, which began May 1, 2005.
Under the new program, physicians can choose to obtain physician-administered drugs from
Medmark, which will then bill FPH directly. Alternatively, physicians can choose to continue to
purchase drugs from a wholesale distributor or manufacturer, bill and receive payment from FPH
as they do currently. For physicians choosing to participate in the program:
• Physicians call Medmark to obtain an intake/Rx form and fax prescription orders to Medmark for
specific members’ medications.
Medmark toll-free fax 1-877-231-8302
Medmark toll-free phone 1-888-347-3416
• Medmark will fill the prescriptions, assist with obtaining authorizations from First Priority Health
and ship the drugs to physicians in time for patients’ visits at which the physicians will administer
the medications.
• Physicians will bill FPH for only the professional services to administer the drugs while Medmark
bills FPH for the drugs. On the HCFA 1500, physicians should include the following information:
– Appropriate Evaluation & Management Code and charges
– Appropriate Administration Code and charges
– Appropriate Drug code and $0.00 for charges
For a complete listing of the drugs included in the program, please refer to the April 2005 issue of
the Bulletin. (Policy number 07060014)