Provided for informational purposes only. May be used for cases where Health First Colorado's drug list designates both a brand drug and its generic equivalent as non-preferred products and also designates that the non-preferred brand product is favored for coverage over the equivalent non-preferred generic. Subsequent incremental fills for DEA Schedule II prescription medications are allowed for members residing in a Long Term Care facility based on NCPDP requirements. The physician is of an opinion that a transition to the generic equivalent of a brand-name drug would be unacceptably disruptive to the patient's stabilized drug regimen and criteria is met for medication. Benefits under STAR. The Michigan Domestic & Sexual Violence Prevention and Treatment Board administers state and federal funding for domestic violence shelters and advocacy services, develops and recommends policy, and develops and provides technical assistance and training. A pharmacy should utilize field 461-EU on a pharmacy claim to indicate 6-Family Plan to receive a $0 co-pay on family planning related medications. Required if needed to provide a support telephone number of the other payer to the receiver. Signature requirements are temporarily waived for Member Counseling and Proof of Delivery. The Transaction Facilitator and CMS . Pharmacies must call for overrides for lost, stolen, or damaged prescriptions. STAKEHOLDER MEETINGS AND COMMENT PERIOD. When timely filing expires due to delays in receiving third-party payment or denial documentation, the pharmacy benefit manager is authorized to consider the claim as timely if received within 60 days from the date of the third-party payment or denial or within 365 days of the date of service, whichever occurs first. Updated Lost/Stolen/Damaged/Vacation Prescriptions section - police report is no longer required for Stolen Medications, PAR Process: Updated notification letter section, Partial Fills and/or Prescription: Updated partial fill criteria, Updated contact information on page 15, to include Magellan's helpdesk info. Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. the blank PCN has more than 50 records. Physician Administered Drugs (PAD) for medications not administered in member's home or in an LTC facility. Copies of all forms necessary for submitting claims are also available on the Pharmacy Resources web page of the Department's website. Pharmacies may call the Pharmacy Support Center to request a quantity limit override if the medication is related to the treatment or prevention of COVID-19, or the treatment of a condition that may seriously complicate the treatment of COVID-19. area. 12 = Amount Attributed to Coverage Gap (137-UP) The new fee-for-service (FFS) pharmacy processing information is as follows: BIN #: 025151 PCN: DRMSPROD Pharmacy Claims and Prior Authorization Call Center number: 1-833-660-2402 Pharmacy Prior Authorization fax number: 1-866-644-6147 Pharmacy Pharmacy contact and plan billing information (PCN/BIN) Mississippi NCPDP D.0 Payer Sheet 2022 Please refer to the October 2020 Medicaid Update article titled Attention: Pharmacies Durable Medical Equipment, Prosthetics, Orthotics, and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service. information about the Department's public safety programs. Information on treatment and services for juvenile offenders, success stories, and more. Required - If claim is for a compound prescription, enter "0. The CIN is located on all member cards including MMC plan cards. Required for partial fills. Information on child support services for participants and partners. Contact the Medicare plan for more information. Required if Other Payer Amount Paid Qualifier (342-HC) is used. Basis of Cost Determination = This is not a required field on the claim, but 05 (Acquisition) or 08 (340B/Disproportionate Share Pricing/Public Health Service) will be accepted if submitted on the claim. Please note, the data below is Part 4 of 6 (H5337 - H7322) with links to Parts 1 through 3 and Parts 5 and 6. A letter was mailed to each member with more information. , was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription drugs. Information on the grant awarded for the State Innovation Model Proposal, Offers resources for agencies who operate the Weatherization Assistance Program in the state of Michigan. . copayments, covered drugs, etc.) Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. Kentucky Medicaid Bin/PCN/Group Numbers effective Jan. 1, 2021 Additional Information Forms Medicaid Assistance Program (MAP) Forms MAC Price Research Request Form FFS PAD Billing PowerPoint Over-the-Counter (OTC) Drug Coverage Managed Care (MCO) Fee for Service (FFS) Provider Resources Billing Instructions Diabetic Supply Drug Information/List The system allows refills in accordance with the number of authorized refills submitted on the original paid claim. If a pharmacy disagrees with the final decision of the pharmacy benefit manager, the pharmacy may file an appeal with the Office of Administrative Courts. Personal care items such as mouth wash, deodorants, talcum powder, bath powder, soap (of any kind), dentifrices, etc. Coordination of Benefits/Other Payments Count, Required if Other Payer ID (Field # 340-7C) is used, Required if identification of the Other Payer Date is necessary for claim/encounter adjudication, CCYYMMDD. We are not compensated for Medicare plan enrollments. Members in the STAR program can get Medicaid benefits like: Regular checkups with the doctor and dentist. These records must be maintained for at least seven (7) years. Quantity Prescribed (Field # 460-ET) for ALL DEA Schedule II prescription drugs, regardless of incremental or full-quantity fills, Quantity Intended To Be Dispensed (Field # 344-HF), Days Supply Intended To Be Dispensed (Field # 345-HG). TheNC Medicaid Preferred Drug List (PDL)allows NC Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates. during the calendar year will owe a portion of the account deposit back to the plan. This publication provides information regarding the Medicaid Pharmacy Carve-Out, a Medicaid Redesign Team (MRT) II initiative to transition the pharmacy benefit from managed care to the Medicaid Fee-for-Service (FFS) Pharmacy Program. Members who were formerly in foster care are co-pay exempt until their 26th birthday, Services provided by Community Mental Health Services, Members receiving a prescription for Tobacco Cessation Product. Required for partial fills. Information on Safe Sleep for your baby, how to protect your baby's life. Days supply for the metric decimal quantity of medication that would be dispensed for a full quantity. these fields were not required. Pharmacy claims must be submitted electronically and within the timely filing period, with few exceptions. Requests for timely filing waivers for extenuating circumstances must be made in writing and must contain a detailed description of the circumstance that was beyond the control of the pharmacy. Although the services covered and the reimbursement rates of the two programs are very similar, the eligibility requirements and If no number is supplied, populate with zeros, Scenario 3 - Other Payer Amount Paid, Other Payer-Patient Responsibility Amount, and Benefit Stage Repetitions Present (Government Programs), OCC codes 0, 1, 2, 3, and 4 Supported (no co-pay only billing allowed), COORDINATION OF BENEFITS/OTHER PAYMENTS COUNT. Required only for secondary, tertiary, etc., claims. Pharmacy contact information is found on the back of all medical provider ID cards. Pharmacies are expected to take appropriate and reasonable action to identify Colorado Medical Assistance Program eligibility in a timely manner. Prescribers may either switch members to a preferred product or may obtain a PA for a non-preferred product. SNO-MED is a required field for compounds - the route of administration is required-NCPDP # ROUTE OF ADMINISTRATION (Field # 995-E2). Lansing, Michigan 48909-7979, Telephone Number: 517-245-2758 01 = Amount Applied to Periodic Deductible (517-FH), 02 = Amount Attributed to ProductSelection/Brand Drug (134-UK), 03 = Amount Attributed to Sales Tax(523-FN), 04 = Amount Exceeding Periodic Benefit Maximum (520-FK), 06 = Patient Pay Amount (Deductible) (505-F5), 08 = Amount Attributed to Product Selection/Non-preferred Formulary Selection(135-UM), 10 = Amount Attributed to Provider Network Selection (133-UJ), 11 = Amount Attributed to Product Selection/Brand Non-Preferred FormularySelection(136-UN), 12 = Amount Attributed to Coverage Gap (137-UP), 13 = Amount Attributed to Processor Fee (571-NZ), MA = Medication Administration - use for vaccine. Plan Name PBM Name BIN PCN Group AETNA CVS Health 610591 ADV RX8834 AMERIGROUP Express Scripts 003858 MA WKLA AMERIHEALTH CARITAS LA PerformRx 600428 06030000 n/a . Plan PBM Phone BIN PCN Group OHA (Fee-for-Service or "Open Card") 888-202-2126 . Information on the Food Assistance Program, eligibility requirements, and other food resources. All Medicaid members are assigned a CIN even if they are enrolled in a Medicaid managed care (MMC) plan. NC MedicaidClinical Section Phone: 919-855-4260Fax: 919-715-1255Email: [email protected], This page was last modified on 01/05/2023, An official website of the State of North Carolina, Outpatient Pharmacy Policies(9,9A,9B, 9Dand9E), Submit Proposed Clinical Policy Changes to the PDL, Preferred Drug List (PDL) and Supplemental Rebate Program Annual Report SFY 2021, NADAC Weekly Files and NADAC Week to Week Comparison files, NADAC Methodology (Part II) and NADAC Help Desk contact information, Pharmacy Provider Generic Dispensing Rate Report, Diabetic Testing and CGM Supplies - Oct. 13, 2022 - EXCEL, Diabetic Testing and CGM Supplies - Oct. 13, 2022 - PDF, Diabetic Testing and CGM Supplies - Sep. 7, 2022 - EXCEL, Diabetic Testing and CGM Supplies - Sep. 7, 2022 - PDF, Diabetic Testing and CGM Supplies - July, 15, 2022 - EXCEL, Diabetic Testing and CGM Supplies - July, 15, 2022 - PDF, Diabetic Testing Supplies & CGM - June 29, 2022 - EXCEL, Diabetic Testing Supplies & CGM - June 29, 2022 - PDF, State Maximum Allowable Cost (SMAC) Pricing Inquiry Worksheet, North Carolina Multidisciplinary Collaboration on Opioid Use and Misuse, Preferred Drug List Opioid Analgesics and Combination Therapy Daily MME, Prior Approval Criteria for Opioid Analgesics, NC Medicaid Opioid Safety - STOP Act Crosswalk (June 2018), Provider Considerations for Tapering of Opioids. Watch the Oct. 12, 2022 Tailored Pan Roll Out Webinar here. The Step Therapy criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring ST is below: Medicaid Common Formulary Workgroup Members. Required when there is payment from another source. ", 00 = If claim is a multi-ingredient compound transaction, Required - If claim is for a compound prescription, enter "00.". BIN: 610494. BNR=Brand Name Required), claim will pay with DAW9. A required field for compounds - the route of administration is required-NCPDP # route of administration is #... Telephone number of the other payer to the plan a compound prescription, enter `` 0 metric decimal of. A support telephone number of the other payer Amount Paid Qualifier ( 342-HC ) is used ( field 995-E2! Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information portion of the Department 's.. 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