April 2022
If you are billing the pharmacy benefit for a 340B claim, please follow the stated guidance to properly submit the claim
- NCPDP Data ELEMENT 409-D9: Ingredient Cost Submitted = 340B Acquisition Cost
- NCPDP Data Element 420-DK: Submission Clarification Code = 20
If you are billing the medical benefit for a 340B claim, please follow the stated guidance to properly submit the claim
- Modifier: UD
- Description: Medicaid level of care 13, as defined by each state
As a reminder, it is required that outpatient Medicaid pharmacy providers (both pharmacy benefit and medical benefit) dispense and administer only rebatable drugs (as determined by the Medicaid Drug Rebate Program) and bill with NDCs. More information can be referenced in Neighborhood’s payment policy: https://www.nhpri.org/wp-content/uploads/2021/07/Payment-Policy-NDC-billing-requirement.20210720-1.pdf
Medical and pharmacy benefit claims submitted with NDC’s that are not rebateable are not covered.
Last updated: April 6, 2022 @ 11:37 am