Governor declared disaster – Rx billing directions

Billing Procedures During Officially Declared States of Emergency

During states of officially declared emergencies, pharmacy providers should bill POS claims as follows:

Enter a value of ’13-Payor Recognized Emergency’ in NCPDP Field ‘420-DK’ when it is necessary to override the following service limit edits:

• Two (2) Brand / Six (6) Prescription Limit
• Early Refill

Please note that when the declared emergency announcement is made, the fields noted above will be opened for the specified time period. Pharmacy providers are advised to use professional judgment in emergency situations. The Division of Medicaid may conduct audits after such events to ensure appropriate care was taken in dispensing medications for affected beneficiaries. Providers and beneficiaries residing and/or receiving care not in an evacuation area must have documentation on file to justify rationale for early/excess fills. Medicaid monies may be recouped if supporting documentation is not found.