LI NET—Pharmacy resources

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.

Qualifying individuals must:

1. Not be enrolled in any other Medicare Part D prescription drug plan
2. Have either Medicare and Medicaid or Medicare and “Extra Help”

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 submit a claim, PDF:

1. 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).
2. 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