Following severe weather and tornadoes that hit Mississippi this past weekend, Gov. Phil Bryant has authorized a State of Emergency to provide resources to aid in recovery efforts. The Mississippi Emergency Management Agency (MEMA) has reported extensive damage caused by a tornado in Forrest County, in addition to other southern regions such as the cities of Hattiesburg and Petal.
Effective Jan. 21, 2017, and throughout the duration of a State of Emergency, the Mississippi Division of Medicaid’s (DOM) Office of Pharmacy has specific emergency billing directions for beneficiary claims, for those beneficiaries residing in affected areas: Forrest, Lamar, Perry, Marion and Jones counties.
Fee-for-service Medicaid beneficiaries
During an officially declared State of Emergency, pharmacists must enter a value of ‘13-Payor Recognized Emergency’ in NCPDP Field ‘420-DK’ when it is necessary to override the following service limit edits:
- 2 Brand/5 Prescription Limit
- Early Refill
Please note, when a State of Emergency is declared, the fields noted above will be opened for the specified time period.
Pharmacy providers are advised to use professional judgment in emergency situations. DOM may conduct audits after such events to ensure appropriate care was taken in dispensing medications for affected beneficiaries.
Providers and beneficiaries who are not residing and/or receiving care in an evacuation area, must have documentation on file to justify rationale for early/excess prescription fills. Medicaid funds may be recouped if supporting documentation is not found.
Coordinated care beneficiaries (MississippiCAN)
Beneficiaries enrolled in our coordinated care program, MississippiCAN, should contact their coordinated care organization for assistance.
- Magnolia Health: Call the Envolve Help Desk for overrides of service limits toll-free at 800-460-8988
- UnitedHealthcare Community Plan: Call the OptumRx’s Help Desk for overrides of service limits toll-free at 877-305-8952
