Managed Care Organization (MCO) and

Fee-For-Service (FFS) Billing Codes


Managed Care Organization (MCO)

*The claim requires the BIN, PCN and Group number for each specific MCO for correct processing.
**Possible previous billing codes are not listed. Please contact specific MCO for past billing codes.
***For possible changes since this posting, please reach out to each MCO.

  MCO Payer Billing Info
If the Primary is…(MCO Plan Name) If the Secondary is… RXBIN RXPCN RXGRP
         
Aetna Better Health of Kansas
(CVS- PBM)
N/A 610591 ADV RX8849
Other Primary- Medicare Part D Aetna Better Health of
Kansas
012114 COBADV RX8849
Other Primary- Commercial Plan Aetna Better Health of
Kansas
013089 COMSEGADV RX8849
         
Sunflower Health Plan
(Envolve/CVS – PBM)
N/A 004336   RX5457
Other Primary - Medicare Part D Sunflower Health Plan 012114   RX5457
Other Primary - Commercial Plan Sunflower Health Plan 013089   RX5457
         
United Healthcare of the Midwest
(Optum Rx – PBM)
N/A 610494 9999 ACUKS
United Healthcare of the Midwest (Optum Rx – PBM) United Healthcare of the Midwest 610097 9999 MPDCSKS
Other Primary - Medicare Part D United Healthcare of the Midwest 610494 4848 ACUKS
Other Primary - Commercial Plan United Healthcare of the Midwest 610494 9999 ACUKS

For Fee-for-Service (FFS)    *No PCN required for processing.

Plan Name RXBIN PCN RXGROUP
FFS 610517 No PCN No Group

03/01/2021