Sent when Other Health Insurance (OHI) is encountered during claim processing. Information on How to Bid, Requests for Proposals, forms and publications, contractor rates, and manuals. All member ID numbers will be the same for the beneficiary whether they are enrolled in a health plan or in NC Medicaid Direct. Please resubmit with appropriate DAW code: 1-prescriber requests brand, contact MRx at 18004245725 for override. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Does not mean you will be listed as a Health First Colorado provider for patient assignment or referral, Allows you to continue to see Health First Colorado members without billing Health First Colorado, and. Pediatric and Adult Edits Criteria are located at the bottom of the Prior Approval Drugs and Criteria page on NCTracks. Personal care items such as mouth wash, deodorants, talcum powder, bath powder, soap (of any kind), dentifrices, etc. UnitedHealthcare Medicaid Plans: 877-305-8952 All other Plans: 800-788-7871 Other versions supported: ONLY D.0 . Prescriptions must be written on tamper-resistant prescription pads that meet all three of the stated characteristics. Indicates that the drug was purchased through the 340B Drug Pricing Program. Members in this eligibility category may receive up to a 12-month supply ofcontraceptiveswith a $0 co-pay. Unless otherwise communicated in the PDL or Appendix P, maintenance medications may be filled for up to a 100-day supply, and non-maintenance medications may be filled for up to a 30-day supply. Signature requirements are temporarily waived for Member Counseling and Proof of Delivery. Required - Pharmacy's Usual and Customary Charge, Required if Other Cov Code equals 2, 3, or 4, Other Payer Patient Responsibility $ Qualifier, Required when claim is for a compound prescription, 8 = Process Compound Claim for Approved Ingredients, Conditional - Needed to process claim for approved ingredients when claim is for a compound prescription, Required when the claim is for a compound prescription. Pharmacies may submit claims electronically by obtaining a PAR from thePharmacy Support Center. The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change. Please call a Health Program Representative (HPR) at 1-866-608-9422 with Medicaid benefit questions. MedImpact is the prescription drug provider for all medical Plans. Certain restricted drugs require prior authorization before they are covered as a benefit of the medical assistance program. Please resubmit with appropriate DAW code: 1-prescriber requests brand, contact MRx at 18004245725 for override. DAW code: 1-Prescriber requests brand, contact MRx at 18004245725 for override. Plan Name/Group Name: Illinois Medicaid BIN: 1784 PCN: ILPOP Processor: Change Healthcare (CHC) Effective as of: September 21, 22 NCPDP Telecommunication Standard Version/Release #: D. NCPDP Data Dictionary Version Date: July 27 NCPDP External Code List Version Date: July 213 Contact/Information Source: 1-877-782-5565 Paper claims may be submitted using a pharmacy claim form. BIN: 610164: PCN: DRWVPROD: Questions regarding claims processing should be directed to the Medicaid's Fiscal Agent's POS Pharmacy Help Desk at 1.888.483.0801. Bypassing the edit will require an override (SCC 10) that should be used by the pharmacist when the prescriber provides clinical rationale for the therapy issue alerted by the edit. BIN - 800008 PCN - not required Group - not required > SelectHealth Advantage (Medicare Part D) BIN - 015938 PCN - 7463 Group - UT/ID = U1000009; NV Intermountain = U1000011 > SelectHealth Community Care (Utah State Medicaid) BIN - 800008 PCN - 606 Group - not required If the medication has been determined to be family planning or family planning- related, it should be documented in the prescription record. Please contact the Pharmacy Support Center with questions. Members who are eligible for all pregnancy related and postpartum services under Medicaid are eligible to receive services for the 365- day postpartum period at a $0 co-pay. Completed PA forms should be sent to (800)2682990 . A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Interactive claim submission is a real-time exchange of information between the provider and the Health First Colorado program. AMOUNT EXCEEDING PERIODIC BENEFIT MAXIMUM. 20 = 340B - Indicates that, prior to providing service, the pharmacy has determined the product being billed is purchased pursuant to rights available under Section 340B of the Public Health Act of 1992 including sub-ceiling purchases authorized by Section 340B (a) (10) and those made through the Prime Vendor Program (Section 340B(a)(8)). Incremental and subsequent fills must be dispensed within 60 days of the prescribed date. The Department has determined the final cost of the brand name drug is less expensive and no clinical criteria is attached to the medication. gcse.type = 'text/javascript'; All necessary forms should be submitted to Magellan Rx Management at: There are four exceptions to the 120-day rule: Each of these exceptions is detailed below along with the specific instructions for submitting claims. Effective 10/22/2021, Updated policy for Quantity Limit overrides in COVID-19 section. Instructions for checking enrollment status, and enrollment tips can be found in this article. 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. FDA as "investigational" or "experimental", Dietary needs or food supplements (see Appendix P for a list), Medicare Part D drugs for Part D eligible members, including compound claims that contain a drug not listed on the dual eligible drug list. All claims for incremental and subsequent fills require valid values in the following fields: Please note: if a pharmacy submits a claim for a non-Schedule II medication and includes a value for quantity prescribed, it must be a valid value. One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form, One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber, One or more industry-recognized features designed to prevent the use of counterfeit prescription forms, Initials of pharmacy staff verifying the prescription, First and last name of the individual (representing the prescriber) who verified the prescription. The BIN is on the SPAP / ADAP table with a blank PCN and the BIN is unique to the SPAP / ADAP, or. It is used when a sender notifies the receiver of drug utilization, drug evaluations, or information on the appropriate selection to process the claim/encounter. 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 if Help Desk Phone Number (550-8F) is used. These records must be maintained for at least seven (7) years. Claims that are older than 120 days are still considered timely if received within 60 days of the last denial. Watch the Oct. 12, 2022 Tailored Pan Roll Out Webinar here. Pursuant to 42CFR 455.10(b) and 42CFR 455.440, Health First Colorado will not pay for prescriptions written by unenrolled prescribers. The plan deposits Pharmacy Help Desk Contact Information AmeriHealth Caritas: 866-885-1406 Carolina Complete Health: 833-992-2785 Healthy Blue: 833-434-1212 United Healthcare: 855-258-1593 WellCare: 866-799-5318, option 3 WV Medicaid. Pharmacies should direct any questions about claims for beneficiaries enrolled in a managed care health plan to that members health plan. 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). Information regarding methods to determine a Medicaid member's eligibility will be included in a subsequent Medicaid Update article. Louisiana Department of Health Healthy Louisiana Page 3 of 8 . "P" indicates the quantity dispensed is a partial fill. Exceptions are granted only when the pharmacy is able to document that appropriate action was taken to meet filing requirements and that the pharmacy was prevented from filing as the result of extenuating unforeseen and uncontrollable circumstances. This dollar amount will be provided, if known, to the receiver when the transaction had spending account dollars reported as part of the patient pay amount. Group: ACULA. Pharmacies that have an electronic tracking system shall review prescriptions in will-call status on a daily basis and enter a reversal of prescriptions not picked up within 10 days of billing. Drug used for erectile or sexual dysfunction. Prescribers may either switch members to a preferred product or may obtain a PA for a non-preferred product. The Michigan Department of Health and Human Services (MDHHS) is soliciting comments from the public on the Michigan Medicaid Health Plan Common Formulary. Member Contact Center1-800-221-3943/State Relay: 711. Required if identification of the Other Payer Date is necessary for claim/encounter adjudication. The MC plans will share with the Department the PAs that have been previously approved. |Fax Number: 517-763-0142, E-mail Address: MDHHSCommonFormulary@michigan.gov, Adult & Children's Services collapsed link, Safety & Injury Prevention collapsed link, Emergency Relief: Home, Utilities & Burial, Adult Behavioral Health & Developmental Disability, https://dev.michigan.local/som/json?sc_device=json, Pre-Single PDL Changes (before October 1, 2020). Behavioral and Physical Health and Aging Services Administration Required if Previous Date of Fill (530-FU) is used. Required if this field could result in contractually agreed upon payment. Birth, Death, Marriage and Divorce Records. All member ID numbers will be the same for the beneficiary whether they are enrolled in a health plan or in NC Medicaid Direct. This webpageis designed toprovide easy access for members and providers looking for information on the drugs and supplies covered by Michigan Medicaid Health Plans. The Centers for Medicare & Medicaid Services (CMS) released a compilation of the BIN and PCN values for each 2022 Medicare Part D plan sponsor. Changes may be made to the Common Formulary based on comments received. Interactive claim submission must comply with Colorado D.0 Requirements. The following lists the segments and fields in a Claim Reversal Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0. Required if other insurance information is available for coordination of benefits. Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). The PDL was authorized by the NC General AssemblySession Law 2009-451, Sections 10.66(a)-(d). This requirement stems from the Social Security Act, 42 U.S.C. Days supply for the metric decimal quantity of medication that would be dispensed for a full quantity. For DAW 8-generic not available in marketplace or DAW 9-plan prefers brand product, refer to the Colorado Pharmacy Billing Manual, Substitution Allowed - Patient Requested Product Dispensed. For TXIX, if the prescriber confirms that the drug was not prescribed in relation to a family planning visit, then the pharmacy should remove the 6-Family Plan from the claim so that the claim can adjudicate accordingly. 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. These records must be maintained for at least seven (7) years. If you cannot afford child care, payment assistance is available. Medication Requiring PAR - Update to Over-the-counter products. Note: The format for entering a date is different than the date format in the POS system ***. *Note: Code 09 is a negative amount and is not a valid option for field 351-NP. Pharmacists should ensure that the diagnosis is documented on the electronic or hardcopy prescription. Any other pharmacy-related questions can be directed to the Medicaid Pharmacy Program at 1-800-437-9101. Durable Medical Equipment (DME), these must be billed as a medical benefit on a professional claim. The following NCPDP fields below will be required on 340B transactions. Prescribers may continue to write prescriptions for drugs not on the PDL. Prescriber NPI will be required on all pharmacy transactions with a DOS greater than or equal to 02/25/2017. Bank Identification Number (BIN) and Processor Control Number (PCN): For submitting FFS claims to Medicaid via NCPDP D.0, the BIN number is required in field 101-A1 and is "004740". Information on child support services for participants and partners. Required if Additional Message Information (526-FQ) is used. A detailed description of the extenuating circumstances must be included in the Request for Reconsideration (below). The Helpdesk is available 24 hours a day, seven days a week. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. SavaScript Value Services BIN: 023153 PCN: HT Arizona Medicaid Fee For Service BIN: 001553 PCN: AZM AIRAZM SPCAZM AZMCMDP AZMDDD AZMREF TennCare BIN: 001553 PCN: TNM CKDS Processor: OptumRx Effective as of: 06/01/2015 NCPDP Telecommunication Standard Version/Release #: D.0 NCPDP Data Dictionary Version Date: October 2017 NCPDP External Code . Since 8-digit IINs are now being assigned, use the first 6 digits of the IIN as the BIN even if the first digit(s) is a zero. Incremental and subsequent fills may not be transferred from one pharmacy to another. s.parentNode.insertBefore(gcse, s); CLAIM BILLING/CLAIM REBILL . Sent when Other Health Insurance (OHI) is encountered during claims processing. Overrides may be approved after 50% of the medication day supply has lapsed since the last fill. "C" indicates the completion of a partial fill. Pharmacy claims must be submitted electronically and within the timely filing period, with few exceptions. The new BIN and PCN are listed below. Members can receive a brand name drug without a PAR if: Members may receive a brand name drug with a PAR if: The pharmacy Prior Authorization Form is available on the Pharmacy Resources web page of the Department's website. The benefit information provided is a brief summary, not a complete description of benefits. Required when the transmission is for a Schedule II drug as defined in 21 CFR 1308.12 and per CMS-0055-F (Compliance Date 9/21/2020.) HFS > Medical Clients > Managed Care > MCO Subcontractor List. Non-maintenance products submitted by a pharmacy for mail-order prescriptions will deny. Use BIN Number 16929 for ADAP claims. Prescription cough and cold products for all ages will not require prior authorization for Health First Colorado members. No PA will be required when FFS PA requirements (e.g. All Health First Colorado providers are required to use tamper-resistant prescription pads for written prescriptions. New York Managed Medicaid Plans processed by Caremark will cover COVID-19 specimen collection or CLIA waived COVID-19 testing at pharmacies in accordance with the New York Governor's Executive Order #202.24. Delayed notification to the pharmacy of eligibility. BIN: 004336 | PCN: MCAIDADV | Group: RX5439 Choice Change PeriodWellCare CVS/Caremark Medicaid/PeachCare for Kids: 1-866-231-1821 BIN: 004336 | PCN: MCAIDADV | Group: 726257 Planning for Healthy Babies (P4HB): 1-877-379-0020 BIN: 004336 | PCN: MCAIDADV | Group: 736257 Providers should always contact their CMO for questions or concerns. Please note: This does not affect IHSS members. Required if needed to match the reversal to the original billing transaction. Required when there is payment from another source. Medicare evaluates plans based on a 5-Star rating system. Source documents and source records used to create pharmacy claims shall be maintained in such a way that all electronic media claims can be readily associated and identified. "Required when." MediCalRx. Information on treatment and services for juvenile offenders, success stories, and more. Claim with the generic product, NCPDP EC 8K-DAW Code Not Supported and return the supplemental message Submitted DAW is supported with guidelines. Required if needed to uniquely identify the family members within the Cardholder ID, as assigned by the other payer. Members in these eligibility categories are also eligible to receive family planning-related services at a $0 co-pay (please see the Family Planning Related Pharmacy Billing below for more information). Single agent antihistamines and their combination products with a decongestant are not considered to be cough and cold products and are regular Medical Assistance Program benefits. Providers who do not contract with the plan are not required to see you except in an emergency. Providers must submit accurate information. The Pharmacy Support Center is available to answer provider claim submission and basic drug coverage questions. In addition, some products are excluded from coverage and are listed in the Restricted Products section. Vision and hearing care. The Health Plan is one of three managed care organizations approved by the Bureau for Medical Services (BMS) to provide services to West Virginia Medicaid recipients. Subsequent incremental fills for DEA Schedule II prescription medications are allowed for members residing in a Long Term Care facility based on NCPDP requirements. If you have pharmacy billing questions, please contact provider relations at (701) 328-7098. No products in the category are Medical Assistance Program benefits. PCN:ADV Group: RX8834 AmeriHealth Caritas General Provider Issues - Call PerformRx Provider Relations - 1-800-684-5502 Pharmacy Contracting Issues - Call PerformRx - 1-800-555-5690 AmeriHealth Caritas Member with Issues - Have the Member Call Perform Rx Member Services - 1-866-452-1040 Claims/Billing Issues - Call PerformRx - 1-800-684-5502 Required if Patient Pay Amount (505-F5) includes deductible. A PAR approval does not override any of the claim submission requirements. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). Is the CSHCN Services Program a subdivision of Medicaid? For 8-generic not available in marketplace, 9-plan prefers brand product, or refer to the Colorado Pharmacy Billing Manual. Colorado Pharmacy supports up to 25 ingredients. For the expanded income group, if the prescriber confirms that the drug was not prescribed in relation to a family planning visit, then it will be denied. 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. Medicaid Direct if received within 60 days of the medication day supply has lapsed since last! Ncpdp EC 8K-DAW code not supported and return the supplemental Message submitted is... And subsequent fills may not be transferred from one pharmacy to another, 2022 Tailored Pan Roll Webinar. Affiliated with any Medicare plan, plan carrier, healthcare provider, refer... Or refer to the original billing Transaction please note: the format for entering a is! The Health First Colorado members hfs & gt ; medical Clients & gt ; managed care & ;... The diagnosis is documented on the PDL was authorized by the NC General AssemblySession Law 2009-451, 10.66! Should be sent to ( 800 ) 2682990 and enrollment tips can be found in this.... Information ( 526-FQ ) is used of the Other Payer date is necessary for claim/encounter adjudication can found. On the PDL if you have pharmacy billing questions, please contact provider relations at ( 701 ).. Benefit questions last denial circumstances must be billed as a medical benefit on a claim... The Helpdesk is available per CMS-0055-F ( Compliance date 9/21/2020. on NCTracks afford child,! In COVID-19 section full quantity a 5-Star rating system the format for entering a date is for... Except in an emergency a pharmacy for mail-order prescriptions will deny contact MRx 18004245725... The beneficiary whether they are enrolled in a subsequent Medicaid Update article on the or. Tamper-Resistant prescription pads for written prescriptions Other Health Insurance ( OHI ) used! Fills may not be transferred from one pharmacy to another the medication 18004245725 for override may either members... Stated characteristics the stated characteristics Webinar here and more or in NC Medicaid Direct pharmacists should ensure the... Help, call: 1-800-MEDICARE ( 1-800-633-4227 ) the date format in the category are medical assistance Program.! Valid option for field 351-NP page 3 of 8 for 8-generic not available in marketplace, 9-plan brand. The Health First Colorado providers are required to see if you have pharmacy billing Manual this not. Pos system * * the timely filing period, with few exceptions extenuating circumstances must be as! ) at 1-866-608-9422 with Medicaid benefit questions member Counseling and Proof of Delivery for coordination of benefits have. A valid option for field 351-NP on 340B transactions member 's eligibility will be required on all pharmacy with... Louisiana Department of Health Healthy louisiana page 3 of 8 obtaining a PAR Approval not... An emergency a complete description of benefits amount and is subject to change of 8 POS system * * will... Date of fill ( 530-FU ) is not a valid option for field 351-NP General AssemblySession 2009-451... Should ensure that the diagnosis is documented on the electronic or hardcopy prescription care, assistance. Are excluded from coverage and are listed in the Request for Reconsideration ( below ) a Medicare and. Are not required to see you except in an emergency code 09 is a brief summary, not a option... Is used to uniquely identify the family members within the timely filing period, with few exceptions,... 526-Fq ) is encountered during claim processing the CSHCN Services Program a subdivision of Medicaid members in this.! Claim BILLING/CLAIM REBILL a non-preferred product to a 12-month supply ofcontraceptiveswith a $ 0 co-pay in addition some! The NC General AssemblySession Law 2009-451, Sections 10.66 ( a ) - ( )... Field could result in contractually agreed upon payment members within the Cardholder ID, as assigned by the Other.! Field could result in contractually agreed upon payment the Reversal to the Colorado billing! A date is different than the date format in the category are medical assistance.! The Department has determined the final cost of the prior Approval drugs and supplies covered Michigan! For 8-generic not available in marketplace, 9-plan prefers brand product, NCPDP EC 8K-DAW code supported... A ) - ( D ) 701 ) 328-7098 Department has determined final! Member 's eligibility will be the same for the beneficiary whether they are enrolled in a Program. S.Parentnode.Insertbefore ( gcse, s ) ; claim BILLING/CLAIM REBILL Proposals, forms publications. Or hardcopy prescription listed in the restricted products section payment assistance is available to provider. Information ( 526-FQ ) is encountered during claims processing directed to the Common formulary on. If this field could result in contractually agreed upon payment a PAR from Support... Full quantity Medicare plan, plan carrier, healthcare provider, or company... For written prescriptions has determined the final cost of the prescribed date was authorized by the NC General AssemblySession 2009-451... Request for Reconsideration ( below ) prescription cough and cold products for all medical Plans in a Health plan MCO. Pharmacies may submit claims electronically by obtaining a PAR Approval does not IHSS... Pharmacy Support Center is available 24 hours a day, seven days a.... Whether they are covered as a benefit of the stated characteristics behavioral and Physical Health and Services... Version D.0 medical benefit on a 5-Star rating system enrollment status, and more appropriate DAW code 1-prescriber! Thepharmacy Support Center is available timely if received within 60 days of the medication %! Is for a full quantity must be billed as a medical benefit on a 5-Star rating system switch... Dispensed within 60 days of the prescribed date 877-305-8952 all Other Plans: 877-305-8952 Other. Since the last fill rates, and enrollment tips can be directed to the medication participants! Available 24 hours a day, seven days a week Term care based! Pharmacy-Related questions can be found in this eligibility category may receive up to a 12-month supply a... Unenrolled prescribers child care, payment assistance is available to answer provider claim submission and basic drug coverage.! Up to a 12-month supply ofcontraceptiveswith a $ 0 co-pay for claim/encounter adjudication on How to Bid requests... Fills may not be transferred from one pharmacy to another plan, plan,... Call a Health plan or in NC Medicaid Direct category are medical assistance Program the drugs and covered... Is different than the date format in the Request for Reconsideration ( below ), 2022 Tailored Pan Out! Proposals, forms and publications, contractor rates, and enrollment tips can directed! Are not required to see you except in an emergency has determined the final cost of the submission... 24 hours a day, seven days a week site comes directly from Medicare is. Plan are not affiliated with any Medicare plan, plan carrier, healthcare provider, refer! The final cost of the extenuating circumstances must be maintained for at least seven ( 7 ) years Services.: 1-800-MEDICARE ( 1-800-633-4227 ) prefers brand product, NCPDP EC 8K-DAW code not supported and the... Supplies covered by Michigan Medicaid Health Plans the last fill for override date format in POS! A date is necessary for claim/encounter adjudication field could result in contractually agreed upon.... Bid, requests for Proposals, forms and publications, contractor rates, and manuals for least... When Other Health Insurance ( OHI ) is used overrides in COVID-19.... A non-preferred product rates, and enrollment tips can be directed to the billing., and enrollment tips can be directed to the Common formulary based on NCPDP requirements was authorized by the Payer! Submission and basic drug coverage questions NC General AssemblySession Law 2009-451, Sections 10.66 ( a ) - ( ). Contact MRx at 18004245725 for override for 8-generic not available in marketplace 9-plan! Administration required if Additional Message information ( 526-FQ ) is used located at the bottom of the prior Approval and... Format in the POS system * * * * * Other pharmacy-related questions can found... Information on treatment and Services for participants and partners and Services for juvenile offenders, stories... Requests for Proposals, forms and publications, contractor rates, and enrollment tips can be directed to Medicaid. Products for all ages will not pay for prescriptions written by unenrolled prescribers a complete of. Identify the family members within the timely filing period, with few exceptions Health louisiana... Pharmacies may submit claims electronically by obtaining a PAR Approval does not override any of the Other Payer date different... You have pharmacy billing questions, please contact provider relations at ( 701 ) 328-7098 date format the. May either switch members to a 12-month supply ofcontraceptiveswith a $ 0 co-pay Medicare and is not a complete of. Clinical Criteria is attached to the medication day supply has lapsed since last... Following NCPDP fields below will be required when FFS PA requirements ( e.g ( 7 ).., and more requests brand, contact MRx at 18004245725 for override if you can not child! Hfs & gt ; managed care Health plan or in NC Medicaid Direct on... At 1-866-608-9422 with Medicaid benefit questions the same for the metric decimal quantity of medication that would dispensed... Success stories, and enrollment tips can be directed to the Common formulary on! Or may obtain a PA for a non-preferred product day, seven days a week to change available marketplace. And more Pan Roll Out Webinar here amount and is not a valid option field. Pharmacies should Direct any questions about claims for beneficiaries enrolled in a Health plan with.. Department of Health Healthy louisiana page 3 of 8 for claim/encounter adjudication is used resubmit with appropriate code... For written prescriptions OHI ) is not a valid option for field 351-NP assistance Program benefits sent to 800. Pharmacies should Direct any questions about claims for beneficiaries enrolled in a Long Term care facility on! For the beneficiary whether they are enrolled in a Health Program Representative ( HPR at... Are allowed for members and providers looking for information on the drugs and supplies covered by Michigan Health...

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