Fillable October 10, 2014 Workers' Compensation Members of Texas (City of Farmers Branch)

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October 10, 2014 Workers' Compensation Members of Texas (City of Farmers Branch)

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October 10, 2014
Workers' Compensation Members of Texas Municipal League Intergovernmental Risk Pool
RE: Progressive Medical, Inc has changed their name to Helios
Texas Municipal League Intergovernmental Risk Pool has used Progressive Medical, Inc. for
pharmacy benefits to all of the Risk Pool’s workers’ compensation members since 2010.
Progressive Medical, Inc has changed their name to Helios effective October 1, 2014.
As part of this name change, a new first fill card is needed to replace the previous first fill card
from Progressive Medical, Inc. A separate attachment to this email is this new Helios first fill
card. When an injured employee reports an injury, the member will need to include their name
in the employer section along with the injured worker’s name, date of accident and social
security number. The injured worker will need to present this card to the pharmacy when taking
their first prescription to get filled. Helios will be mailing a prescription card to the injured
employee to present to the pharmacy for future prescriptions. Please discontinue using the
Progressive Medical first fill card. The Risk Pool’s website also has this new card, as well as
the Workers’ Compensation Claims staff.
Using this first fill letter and the prescription cards will reduce costs of prescriptions below the
state fee schedule and lower the claims costs that directly impacts the member’s workers’
compensation claims experience. Using this pharmacy benefit management program has
lowered actual costs by $1.2 million dollars in the last 12 months.
If you have questions about this first fill card or pharmacy benefit management process, please
contact your respective claims specialist in the Workers’ Compensation Claims Department at
800 537-6655 or by email, WorkersCompensation@tmlirp.org.
Sincerely,
Mike Bratcher
Workers' Compensation Claims Manager
Texas Municipal League Intergovernmental Risk Pool
Helios has been chosen to manage your workers’ compensaon pharmacy benets for your employer or their
insurer. Below is your First Fill card that will allow you to receive your injury-related prescripons at your local
pharmacy. Please ll out the card based on the instrucons below.
Employer:
Immediately upon receiving noce of injury, ll in
the informaon above and give this form to the employee.
Injured Employee:
If you need a prescripon lled for a work-related injury or
illness, go to a Helios Tmesys network pharmacy. Give this
temporary card to the pharmacist. The pharmacist will ll your
prescripon at low or no cost to you.
If your workers’ compensaon claim is accepted, you will
receive a more permanent pharmacy card in the mail.
Please use that card for other work-related injury or illness
prescripons.
Most pharmacies, including all major chains, such as
Walgreens, CVS, Rite Aid, Walmart, Target, and more, are
included in the network. To nd a network pharmacy call
877.229.0649 or visit www.tmesys.com and click on “Pharmacy
Locator.”
NOTE: This First Fill card is only valid for your workers’ compensaon injury or illness.
P.O. Box 152539
Tampa, FL 33684-2539
MAKING IT EASY...
TO GET WORKERS’ COMPENSATION PRESCRIPTIONS FILLED.
Rx
Rx
877.229.0649
Quesons? Need Help?
IMP14-1414-10-ADJ
Noce to Cardholder: Present this card to the pharmacy to receive medicaon for your
work-related injury. To locate a pharmacy: www.tmesys.com\pharmacy-locator
Download Free Mobile App: www.tmesys.com\MyWorkComp
DATE OF INJURY (YYMMDD)
EMPLOYER
Aenon Pharmacists: Enter RxBIN, RxPCN, and GROUP. Member ID # format is the
date of injury, and SSN combined as follows: YYMMDD123456789.
Tmesys is the designated PBM for this paent.
Tmesys Pharmacy
Help Desk 877.229.0649
RxBIN
004261
CAL
002538
or
or
Envoy Acct. #
NDC Envoy
RxPCN
SOCIAL SECURITY NUMBER
CARRIER/TPA
INJURED WORKER NAME
GROUP
TMLIRP
E504
Helios ha sido elegido para administrar los benecios farmacéucos de su programa de compensación por
accidentes laborales para su empleador o su asegurador. Más adelante incluimos su tarjeta First Fill que le per-
mirá recibir las recetas médicas relacionadas con su lesión en su farmacia local. Llene esta tarjeta siguiendo
las instrucciones que se indican a connuación.
Empleador:
Inmediatamente después de recibir un aviso sobre una
lesión, llene la información antes indicada y entregue este
formulario al empleado.
Empleado lesionado:
Si necesita que se le abastezca su receta médica para una lesión
o enfermedad relacionada con su trabajo, visite una farmacia
de la red Helios Tmesys. Entregue esta tarjeta temporal al
farmacéuco. El farmacéuco abastecerá su receta médica a
bajo costo o sin costo alguno.
Si se acepta su reclamación del programa de compensación
por accidentes laborales, recibirá una tarjeta permanente por
correo. Use esa tarjeta para otras recetas médicas de lesiones o
enfermedades relacionadas con su trabajo.
La mayoría de farmacias, incluyendo todas las principales
cadenas como Walgreens, CVS, Rite Aid, Walmart, Target, y
más, forman parte de la red. Para encontrar una farmacia de la
red, llame al 877.229.0649 o visite www.tmesys.com y haga clic
en “Pharmacy Locator” (Localizador de farmacias).
P.O. Box 152539
Tampa, FL 33684-2539
HACEMOS MÁS SENCILLO...
EL ABASTECIMIENTO DE LAS RECETAS MÉDICAS DEL PROGRAMA DE
COMPENSACIÓN POR ACCIDENTES LABORALES.
Rx
Rx
877.229.0649
¿Tiene alguna pregunta?
¿Necesita ayuda?
IMP14-1414-10-ADJ
NOTA: Esta tarjeta First Fill solo es válida para una lesión o enfermedad cubierta por su programa de compensación por accidentes laborales.
Aviso para el tular de la tarjeta: Presente esta tarjeta a la farmacia para recibir los medica-
mentos para la lesión relacionada con su trabajo. Para ubicar una farmacia, visite www.tmesys.
com\pharmacy-locator
Descargue la aplicación móvil gratuita en www.tmesys.com\MyWorkComp
NOMBRE DEL TRABAJADOR LESIONADO
FECHA DE LA LESION (AAMMDD)
PORTADORA EMPLEADOR
NUMERO DE SEGURO SOCIAL
Aenon Pharmacists: Enter RxBIN, RxPCN, and GROUP. Member ID # format is the
date of injury and SSN combined as follows: YYMMDD123456789.
Tmesys is the designated PBM for this paent.
Tmesys Pharmacy
Help Desk 877.229.0649
RxBIN
004261
CAL
002538
or
or
Envoy Acct. #
NDC Envoy
RxPCN
GROUP
TMLIRP
E504
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October 10, 2014 Workers' Compensation Members of Texas (City of Farmers Branch)

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Completed 3 August 2020

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