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Pharmacy reimbursement: Revised reprocessing schedule

The Mississippi Division of Medicaid (DOM) has heard pharmacy providers’ concerns and adjusted the claims reprocessing schedule originally noted in the Late Breaking News, sent on Aug. 3, 2017, titled “Pharmacy Reimbursement/Reprocessing”. The dates noted in the schedule reflect that reprocessing will be performed over 10 months, rather than five months as originally scheduled.

Automatic pharmacy claims reprocessing of point-of-sale, fee-for-service and MississippiCAN pharmacy claims with dates of service April 1, 2017, through Aug. 31, 2017, will be performed beginning the first week of October and reflected on the Oct. 9, 2017 remittance advice statements. Reprocessing will be performed in biweekly increments over a total time frame of no less than 10 months. Note: providers do not need to reverse and resubmit claims manually.

In an effort to support providers during this adjustment period, DOM has made an estimated financial impact available to pharmacy providers. The estimated impact is based upon reprocessing fee-for-service and MississippiCAN pharmacy point-of-sale claims filed in the month of April 2017.  Estimated financial impacts for the months of May through August will be available to providers from Mercer no later than Sept. 18, 2017.

Providers can contact the Mercer Call Center to obtain their estimated financial impact total for the month of April 2017, by phone at 855-612-6863.

To receive this information via secure email or when inquiring for more than 10 pharmacies, email your request to MSMedicaidRx@mercer.com and include your pharmacy name, address, Medicaid ID number and phone number.

For other questions, contact DOM’s Office of Pharmacy by phone at 601-359-5253 (select option #4), or refer to the Frequently Asked Questions document on the Pharmacy page of the DOM website.

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