"We work for the patient´s well - being and the rational use of medications." -

Thousands of patients benefit from the various programs and services offered by MC-21 for their well-being.

Member Portal

This is an unparalleled functionality through MC-21´s electronic portal, by which members can conveniently access the specific information of their pharmacy benefits plan and general information on medications. Through the members´ portal there is access to the patient´s medication history, to a pharmacy on line locator, to access and award a prescription or calculate the cost of a medicine before visiting the pharmacy, among others.

Member Call Center

The Members Call Center is available to answer their questions free of charge and 24/7. It operates through an advanced telecommunications system that includes help lines. For help, please call the telephone number in the back of your medical insurance card.

Mail Order Call Center

For members that request it and qualify, some maintenance medications for certain therapies could be conveniently available by mail order and delivered to your house. Maintenance medications are those used to treat long-term conditions such as diabetes, hypertension and cholesterol, among others.

If your health plan includes the mail order option, there are three ways to receive your medication:

Direct Member Reimbursement

This is a tool for direct member reimbursement of claims. To request a reimbursement, print and complete the request reimbursement form. It is important that the document contains all of the member´s required information, signature and other required documents. The reimbursement form should be sent with all other requested documents to the address indicated in the document. For help, please refer to the telephone number in the back of your medical insurance card.

Communication to Members

MC-21´s experienced personnel periodically publishes health related articles in newsletters, magazines and newspapers on topics such as formulary changes, clinical guidelines, and new therapies, among others.

Also, our members may access www.healthcoach4me.com as additional support. This portal includes tools and useful tips for improving your health and well-being.

Important Links

Following, there is a list of links with information on the most common health conditions and their respective treatments.

Complaints

If you have complaints about the services received, please complete the following document in all its parts to be evaluated by the Customer Affairs Department.

Complaint Form

Appeals and Exceptions Process

Appeals Process

You may submit an appeal for evaluation, following the steps described below. The documentation submitted must be readable and thoroughly completed.

  •          Send a letter of appeal
  •          Include a notification signed by your physician to support your appeal
  •          Send these documents via fax to 1-866-894-8197 or via regular mail to:

Customer Affairs Department
MC-21 Corporation
Call Box 4908
Caguas, PR 00726

 

Appeals must be received within 15 days after receiving a denial notification. The decision taken upon your appeal will be notified to you in written before 10 working days after it is issued.

 

Exceptions Process

You may submit an exception for evaluation, following the steps described below. The documentation submitted must be readable and thoroughly completed.

  •          Send an exception request
  •          Include a notification signed by your physician to support your exception request
  •          Send these documents by fax to 1-866-894-8197 or via regular mail to:

Customer Affairs Department
MC-21 Corporation
Call Box 4908
Caguas, PR 00726

 

 

Medication Therapy Management Program

Designed to satisfy the needs of members under Medicare Part D coverage, this program offers services through an interdisciplinary clinical team for treating chronic conditions such as asthma, diabetes, COPD, hypertension and hypercholesterolemia. It focuses on optimizing the therapeutic results through orientation in the adequate use of medication and the reduction of serious side effects, including adverse medication interactions.

Medication Adherence Program

This program is focused on improving our member´s service quality by providing ways for them to stay in their treatment. The program aims at integrating all patients´ care participants in promoting therapy adherence, guarantee the appropriate use of medication, and insure a top level of care and satisfaction while helping patients manage their conditions.

E-Prescribing

The E-prescribing program gives physicians real time information on eligibility, clinical and in formulary, patients´ past and current medication history, safety alerts on drug interactions and drug allergies, and other medication related problems. This information is available to physicians at prescription time, which promotes the integration of patient´s pharmacy benefits, such as mail ordering, prior authorizations and compliance, among others. E-prescribing improves the safety of patients and physicians´ care.

Retail Pharmacy Networks

MC-21 retail pharmacy network includes over 900 pharmacies in Puerto Rico and more than 69,000 in the United States, as well as a mail order pharmacy network. Our specialty pharmacy network integrates the implementation of clinical interventions in 100% of the managed cases. We also have the Flex 90 program, a 90-day maintenance medication dispensing program in a single pharmacy visit. This program is available in our pharmacy networks in Puerto Rico and the United States. The patient should discuss the convenience of this option with his/her physician.

MC-21 includes:

  • Specialty Pharmacy Networks
  • Mail Order Pharmacy Network
  • US Pharmacy Networks
Fraud Waste and Abuse Program

The Fraud, Waste and Abuse Program (FWA), in support of MC-21 ´s pharmacy network, consist of three main components: Prevention, Detection and Correction. We have a Pharmacy Education Program in place which goal is to keep our pharmacy network updated on how to prevent, identify and report potential fraud, waste and abuse cases. Every person has the right, obligation and responsibility to inform about suspicious activities or possible fraud, waste and abuse guidelines and regulations. Providing information can be done confidentially through the following channels:

Telephone-(787) 286-6032
Hotline- Extension 3800
FWA Unit Extension 3122
Fax-(787) 653-2854
E-mail-cumplimiento@mc-21.com
Mail- Call Box 4908
Caguas, PR 00726

Coordination of Benefits (COB)

Our claims processing and adjudication system includes an application for the Coordination of Benefits (COB) at the time of dispensing medications. Through the patients´ eligibility process, the COB code is activated to indicate if the patient has an alternate health insurance plan and, according to the information on file, the primary and secondary health plans are defined at dispensing time.