Index - Outpatient Pharmacy Newsletter
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2013
A+KIDS Facsimile Form Revision, 1/13
Announcement of Monitoring Parameters Associated with the Hemophilia Specialty Pharmacy Program Policy, 2/13
Changes in Drug Rebate Manufacturers, 1/13, 2/13 , 3/13, 4/13
Clinical Coverage Policies, 3/13
Concurrent Use of Methadone and Benzodiazepines, 3/13
Corrected 1099 Requests for Tax Years 2010, 2011, and 2012: Action Required by March 1, 2013, 1/13
Delay in Non-Enrolled Prescriber Edit, 2/13, 3/13
Hemophilia Specialty Pharmacy Program, 1/13
Maintaining the Security and Accessibility of Records after a Provider Agency Closes, 2/13
NC DHHS Secretary Wos Calls for Immediate Freeze on Old Medicaid Computer System, 2/13
NCTracks Currently Enrolled Provider (CEP) Registration Process, 4/13
NCTracks: The new multi-payer system for N.C. DHHS coming on July 1, 2013, 3/13
NCTracks Provider Checklist for Go-Live, 4/13
NCTracks: Providers Should Verify Trading Partners NCTracks Certification, 4/13
NCTracks Provider Training Opportunities, 4/13
New BIN Instructions for the Roche ACCU-CHEK Free Meter Program, 1/13
No Copayments for Pregnant Medicaid Beneficiaries, 1/13
Pharmacy Dispensing Fee Changes, 1/13
Pro-Air HFA Moves to Preferred Status on April 1, 2013, 2/13 , 3/13
Recipient Opt-In Program and Monthly Prescription Limits, 1/13
Updated Federal Upper Limit Reimbursement List, 1/13 , 2/13 , 3/13, 4/13
2012
2013 Checkwrite Schedule, 10/12 , 11/12
340B Purchased Drugs, 7/12
A+KIDS Medicaid and Health Choice - Unlimited Overrides End on March 15, 2012, 2/12
Automatic Refills and Automatic Shipments No Longer Allowed Upcoming Policy Implementation: Phase I starts February 8, 2012, 1/12
Benzodiazepines and Barbiturates No Longer Covered for Dual Eligibles, 12/12
Benzoyl Peroxide Products, 12/12
Billing Claims for Beneficiaries with Medicare Deductibles, 11/12
Changes in Drug Rebate Manufacturers, 1/12, 2/12, 3/12 , 4/12 , 5/12 , 6/12, 7/12 , 8/12 , 9/12 , 10/12 , 11/12 , 12/12
Change to Medicaid Identification (MID) Card, 4/12
Clinical Coverage Policies, 2/12, 9/12
Corrected 1099 Requests for Tax Years 2009, 2010, and 2011 - Action Required
by March 1, 2012, 2/12
Coverage of Synagis for the 2012 -2013 Season, 8/12
Deleted NDC from CMS, 6/12
Dispense as Written for Medicaid Recipients Point of Sale Overrides for Antipsychotic Programs, 5/12
Enrollment and Application Fees Clinical Coverage Policies Updated Federal Upper Limit Reimbursement List 2013 Checkwrite Schedule Changes in Drug Rebate Manufacturers, 12/12
Enrollment Application Status Inquiries, 4/12
Hemophilia Specialty Pharmacy Program, 12/12
Implementation of the Patient Protection and Affordable Care Act Requirements – Credible Allegation of Fraud and Payment Suspension, 2/12
Keeping Your Medicaid Provider Record Current, 2/12
Maintaining the Security and Accessibility of Records after a Provider Agency Closes, 5/12
Medicaid Providers Must Screen for Individual & Entity Exclusion, 2/12
Mirena Return Process for Physician’s Offices, 7/12
N.C. Health Choice Claims Processing Transition, 1/12
N.C. Health Choice Providers with Outstanding Medical Claims with Dates of Services Prior to October 1, 2011, 4/12 , 6/12
N.C. Medicaid and Health Choice Antipsychotics Programs – Pharmacy POS Override Code Protocol, 3/12
N.C. Medicaid and Health Choice Copayment Policy, 8/12
N.C. Medicaid and Health Choice Preferred Drug List Changes Prescribers Not Enrolled in the Medicaid Program, 10/12
N.C. Medicaid Provider Direct Enrollment and Screening, 8/12
N.C. Medicaid Tamper Resistant Guidelines Update, 3/12
N.C. Medicaid Tamper Resistant Prescription Pad Guidance Update, 5/12
NCPDP D.0 -Edit 0918 and Billing Compounds, 1/12
New BIN Instructions for the Roche ACCU-CHEK Free Meter Program, 12/12
New Prior Authorization Requirements for Incivek, Victrelis, Kalydeco, and Cialis, 10/12
NPI Only – September 19, 2012, 7/12 , 8/12
NPI Update for Pharmacy Providers, 6/12
Office Relocation: Program Integrity, Finance Management, Hearings, 5/12
Off Label Antipsychotic Safety Monitoring in Health Choice Recipients, 1/12
Payment Error Rate Measurement (PERM) in North Carolina, 8/12
Pharmacy Claim Forms, 1/12
Pharmacy Dispensing Fee Changes, 12/12
Pharmacy Generic Dispensing Fee Change, 1/12
Pharmacy Reimbursement Change, 8/12
Photo Identification Required Prior to Dispensing Certain Controlled Substances, 2/12
Point-of-Sale Override for Leukotrienes, Statins, Orally Inhaled Steroids, and Second Generation Anticonvulsants, 1/12
POS Reversals, 8/12
Prescribers Not Enrolled in the Medicaid Program, 11/12 , 12/12
Prescribing and Documenting Brand Medically Necessary Drugs, 6/12
Procedures for PA Request for Synagis for RSV Season 2012-2013, 9/12
Processing Changes for Duplicate Remittance and Status Reports (RAs), 10/12
Provider Enrollment Fee Submitting Provider Refund, 1/12
Provider Self-Audit Protocol, 4/12
Recipient Opt-In Program and Monthly Prescription Limits, 12/12
Replacement MMIS – NCTracks Information, 3/12
Reporting Managing Relationship Changes, 2/12
Revised Prior Authorization Requirements for Leukotriene Modifiers, 10/12
Roche ACCU-CHEK Diabetic Supplies Program – Override Extended Until April 30, 2012, 3/12
Roche ACCU-CHEK Diabetic Supplies Program Reminder, 6/12
Roche ACCU-CHEK Diabetic Supplies Under the DME and Pharmacy Programs, 1/12
Roche Provider Rebates, 4/12 , 10/12
Roche Provider Rebates – Revised Implementation Date – July 1, 2012, 6/12
Roche Provider Rebates Update, 5/12
Subscribe and Receive Email Alerts for Medicaid Updates, 4/12 , 11/12
Syringe and Pen Needle Coverage through Pharmacy Point-of-Sale, 1/12
Termination of Inactive N.C. Medicaid and N.C. Health Choice Provider Numbers, 8/12
Two Women Plead Guilty to Health Care Fraud Conspiracy and Related Offenses Basic Medicaid and NC Health Choice Seminars, 3/12
Updated Federal Upper Limit Reimbursement List, 1/12 , 2/12 , 3/12 , 4/12 , 5/12 , 6/12 , 7/12 , 8/12 , 9/12 , 10/12
Upcoming Policy Implementation: BRANDS Monitoring, 4/12 , 5/12
Upcoming Policy Implementation: March 20, 2012 Off Label Antipsychotic Safety Monitoring in Recipients 18 and older, 2/12
Updated EOB Code Crosswalk to HIPAA Standard Codes Resolving Denied Claims – HPES Call Center, 11/12
2011
Affordable Care Act Implementation Updates, 6/11 , 7/11
Audits and Post Payment Reviews, 10/11
Automatic Refills and Automatic Shipments No Longer Allowed, 11/11
Basic Medicaid Seminars, 8/11
Billing Instructions for Submitting Diabetic Supplies under DME, 11/11
Blood Glucose Monitors, 11/11
Changes in Drug Rebate Manufacturers, 1/11 , 2/11 , 3/11 , 4/11 , 5/11 , 6/11 , 7/11 , 8/11 , 9/11 , 10/11 , 11/11, 12/11
Changes to the N.C. Medicaid Preferred Drug List, 2/11
Clinical Coverage Policies, 1/11
Compounded Hydroxyprogesterone Caproate (known as 17P) Continues to be Available in the Physician’s Drug Program and Outpatient Pharmacy Program, 5/11
Compounded Hydroxyprogesterone Caproate (known as 17P) continues to be Available in the Physician’s Drug Program, 6/11
Corrected 1099 Requests for Tax Years 2008, 2009, and 2010: Action Required by March 1, 2011, 1/11
Coverage of Prescription Vitamins and Mineral Products for N.C. Medicaid Recipients, 3/11
Deleted NDC’s from CMS, 5/11 , 6/11 , 10/11
DHHS/DMA Program Integrity Contract with Public Consulting Group, 4/11
Drug Utilization Review Early Refill Alert, 5/11
Drug Utilization Review Intervention Letters, 1/11
Electronic Billing of the Prior Authorization 72-Hour Emergency Supply, 4/11
Enactment of the Affordable Care Act, 6/11
Enrollment Fee Final Notice, 6/11
Federal Upper Limit Reimbursement, 11/11
Forms Required for Processing Payment of North Carolina Health Choice Claims, 10/11
Health Choice Transition, 7/11 , 10/11
HIPAA 5010 and NCPDP D.0 Implementation, 3/11
HIPAA ASC X12 5010 Implementation, 10/11
Legislative Update, 8/11
Letter of Attestation Revision, 10/11 , 12/11
Makena No Longer Covered Under the Outpatient Pharmacy Program, 11/11
Medicaid Fraud: Protect Your Tax Dollars, 10/11
Medicaid and Health Choice Provider Payment Suspensions, 11/11
Medical Record Requests for Program Integrity Post Payment and Prepayment Reviews, 12/11
Medicare Crossover Claims, 1/11
Monthly Prescription Limitations and the Opt-In Program, 5/11
N.C. Division of Medical Assistance - Program Integrity Unit: What you need to know, 10/11
N.C. Health Choice Claims Processing Transition Reminder, 12/11
N.C. Health Choice Transition, 9/11
N.C. Health Choice (NCHC) Proposed Clinical Coverage Policies, 10/11
N.C. Medicaid Preferred Drug List Changes, 9/11
N.C. Medicaid Preferred Drug List Changes – Revised Date, 10/11
N.C. Medicaid Preferred Drug List Changes Vacation Supply Prescriptions Limited to Once a Year, 11/11
NCPDP D.0 Implementation Schedule, 8/11 , 9/11 , 10/11 , 11/11 , 12/11
New Prior Authorization Requirements for Vusion Ointment and Xolair Injection, 9/11
No Copayments for Family Planning Recipients, 1/11
NPI Update for Pharmacy Providers, 2/11 , 4/11 , 5/11
Office of Medicaid Management Information System Services Website, 1/11
Off Label Antipsychotic Monitoring in Children through Age 17, 7/11
PDF Format Remittance and Status Reports, 1/11
Pharmacies Participating in the 340b Program Provider Quality Assurance Questionnaire, 2/11
Pharmacy Generic Dispensing Fee Change, 12/11
Phase Two Implementation: Off Label Antipsychotic Monitoring in Children through Age 17, 8/11
Point-of-Sale Override for Leukotrienes, Statins, Orally Inhaled Steroids, and Second Generation Anticonvulsants, 11/11
Policy Implementation: Off Label Antipsychotic Monitoring in Children through Age 17, 3/11
Procedures for PA Request for Synagis for RSV Season 2011/2012, 8/11, 9/11
Process for Returning Unused Mirena Units, 2/11
Provider Billing of Patients Who Are Medicaid Recipients, 2/11
Provider Responsibilities in a Program Integrity Review or Audit, 11/11
Provider Verification, 5/11
Quality Assurance Questionnaire, 5/11
Recipient Management Lock-In Program, 5/11
Recredentialing of Medicaid Providers, 12/11
Removal of AWP from First DataBank, 9/11
Reporting Provide Fraud and Abuse, 9/11
Requesting Roche Provider Rebates, 12/11
Requirements of Medicaid and Health Choice Providers, 8/11
Roche ACCU-CHEK Diabetic Supplies Under the DME and Pharmacy Programs, 11/11 , 12/11
Submitting Claims on Paper: Optical Character Recognition Technology, 1/11
Subscribe and Receive Email Alerts for Medicaid Updates, 10/11
Terminated NDC’s, 11/11
Termination of Inactive Medicaid Provider Numbers, 7/11 , 8/11 , 9/11
Transition Period for Oral Inhaled Corticosteroids, Leukotrienes, and Statins, 1/11 , 3/11
Upcoming Changes, 7/11
Upcoming Change to N.C. Health Choice Recipient Co-Payments, 9/11
Upcoming Policy Implementation: Off Label Antipsychotic Monitoring in Children through Age 17, 2/11
Update: Active Pharmaceutical Ingredients and Excipients, 2/11
Updated Federal Upper Limit Reimbursement List, 12/11
Update on NC Tracks, 8/11
Update to Provider Self Audit Process, 10/11 , 12/11
Vacation Supply Prescriptions Limited to Once A Year, 9/11
W-9, 6/11
2010
2010 Census, 3/10
Additional Information on Prodigy Diabetic Supplies, 1/10 , 2/10 , 5/10
Addition of Pen Needles to Pharmacy Point-of-Sale, 2/10
Changes in Drug Rebate Manufacturers, 1/10, 2/10 , 3/10 , 4/10 , 5/10 , 6/10 , 7/10 , 8/10 , 9/10 , 10/10 , 11/10 , 12/10
Changes to the North Carolina Medicaid Preferred Drug List, 7/10
Clarification on the Provider Enrollment Fee, 3/10
Contact E-Mail Addresses, 11/10
Coverage of Over-The-Counter Second Generation Antihistamine and Decongestant Combinations, 8/10
Coverage of Prescription Vitamin and Mineral Products, 7/10
Deleted NDC’s from CMS, 3/10 , 4/10 , 7/10 , 8/10, 10/10
Discontinuation of Focused Risk Management Program, 11/10 , 12/10
Early and Periodic Screening, Diagnosis and Treatment and Applicability to Medicaid Services and Providers, 1/10 , 3/10
Early Refill Override Instructions, 2/10
End-dated Coverage for Exocrine Pancreatic Insufficiency Drugs, 5/10 , 6/10
End-dated Coverage of Generic Colchicine, 11/10
Enrollment Fee Clarification, 11/10
Enrollment Fee Reminder, 12/10
Enrollment Fees Upate Reminder, 9/10
HP Enterprise Services Address Change, 2/10
False Claims Act Education Compliance for Federal Fiscal Year 2009, 10/10
HP Mailing Address Changes, 3/10
Implementation of a Recipient Management Lock-In Program, 7/10 , 9/10
Important Safety Information on Valproate, 7/10
Incomplete Application Final Notice, 12/10
Incomplete Application Final Notice, 11/10
Incomplete Provider Enrollment Applications, 6/10
Lost Prescriptions Limited To One Occurrence During 365-Days Time Period, 7/10
Maintaining the Security and Accessibility of Records after a Provider Agency Closes, 5/10
Medicaid Integrity Contractors Audit, 4/10
Medicaid Provider Participation Agreement, 6/10
Medicaid Provider Payment, 3/10
Medicare and Medicaid Health Information Technology: Title IV of the American Recovery and Reinvestment Act, 9/10
North Carolina Medicaid Preferred Drug List, 2/10 , 3/10 , 4/10 , 5/10
Offering Gifts and Other Inducements to Beneficiaries, 6/10
Optical Character Recognition for Paper Claims, 7/10
Payment Error Rate Measurement in North Carolina, 4/10
Pharmacy Prior Authorization: Response Times and Emergency Supplies, 10/10
Point-of-Sale Overrides for Leukotrienes, Statins, Orally Inhaled Steroids, and Second Generation Anticonvulsants, 8/10
Policies on Emend, Leukotrienes, Lidoderm, Orally Inhaled Corticosteroids, Statins and Suboxone; Revised Policies on CII Narcotic Analgesics and Second Generation Anticonvulsants, 8/10
Procedures for Prescribing Synagis for RSV Season 2010/2011, 9/10
Provider Enrollment Application Process, 10/10
Provider Information Regarding Changes in NC Health Choice Administration, 5/10
Provider Information Regarding Changes in NC Health Choice Benefits, 5/10
Provider Information Regarding Changes in NC Health Choice Copayments, 5/10
Recipient Management Lock-in Program Emergency Fill, 9/10
Recipient Notifications, 9/10
Reinstatement of NDCs from CMS, 2/10
Remittance and Status Reports in PDF Format, 4/10 , 5/10 , 6/10
Removal of Active Pharmaceutical Ingredients and Excipients as Covered Outpatient Drugs, 11/10 , 12/10
Reporting Fraud, Waste, and Program Abuse, 3/10
Requirement for Internal Claim Number on Self-Audits, 10/10
Responding to DUR Alerts, 2/10
State Medicaid Health Information Technology Plan, 6/10
Substitution for Duoneb and Insulin Cartridges and Pens, 8/10
Substitution of Preferred Brand Drugs, 8/10
Suboxone, Subutex, and Buprenorphine Prior Authorization, 12/10
Synagis Pharmacy Claims for 2009/2010 Season, 5/10
Syringe and Pen Needle Coverage through Pharmacy Point-of-Sale Deleted NDC’s from CMS, 10/10
Update to the Annual Medicaid Identification Card, 7/10
Update on Drug Interaction of Clopidogrel Bisulfate with Omeprazole, 2/10
Update on the N.C. Health Information Technology Plan and Schedule, 11/10
Utilization of Acetaminophen Prescription Products Greater Than 4 Grams/Day, 2/10
2009
2009/2010 Procedures for Prescribing Synagis for RSV Season, 9/09
2010 Checkwrite Schedule, 10/09
Addition of Dispense As Written Code “8,” 5/09
Additional Information on Prodigy Diabetic Supplies, 12/09
Basic Medicaid Seminars, 2/09
Billing for Focus Risk Management (FORM) Reviews, 10/09
Change in Banks for EDS, 1/09
Changes in Drug Rebate Manufacturers, 1/09, 2/09, 3/09 , 4/09, 5/09, 6/09 , 7/09 , 8/09 , 9/09, 10/09, 11/09, 12/09
Changes to Prior Authorization Criteria for Growth Hormone, 4/09
Changes to Prior Authorization Criteria for Sedative Hypnotics, 4/09
Changes to Prior Authorization Requirements for Antinarcolepsy/Antihyperkinesis
Agents, 8/09
Changes to Prior Authorization Requirements for Proton Pump Inhibitors, 8/09
Clarification for Completing the W-9, 7/09
Clarification on the Insulin Syringe Billing, 7/09
Clinical Coverage Policies, 2/09 , 5/09 , 8/09
CMS Update: Notification of Covered Drugs, 10/09
Computer Sciences Corporation to Assume N.C. Medicaid Provider Enrollment, Credentialing, and Verification Activities, 3/09
Controlled Substances Reporting System - The State’s Newest Tool to Make
Prescribing Opioids and Other Controlled Substances Safer and Easier, 6/09
Copayments and Copayment Exemptions, 12/09
Corrected 1099 Requests for Tax Years 2006, 2007, and 2008 – Action Required by March 1, 2009, 1/09
Corrected 1099 Requests for Tax Years 2007, 2008, and 2009: Action Required by
March 1, 2010, 12/09
CSC to Assume N.C. Medicaid Provider Enrollment, Credentialing, and
Verification Activities, 4/09
CSC to Initiate 12-Month Provider Verification and Credentialing Activities, 7/09
Deleted NDCs from CMS, 3/09, 4/09 , 5/09, 09/09
DHHS Awards Contract for Replacement MMIS, 2/09
DMA Budget Initiative Web Page, 7/09
DMA Organizational Announcement, 8/09
DMA Website Redesign, 1/09 Drug Utilization Review Early Refill Alert, 11/09
Early and Periodic Screening, Diagnosis and Treatment and Applicability to
Medicaid Services and Providers, 6/09, 9/09
EDS Announces New Name, 10/09
Electronic Claims Submission, 7/09
Electronic Claim Submission Exceptions, 8/09, 9/09
Electronic Funds Transfers, 7/09, 9/09
Electronic Recipient Eligibility Verification Tool, 9/09
Emergency Supplies for Recipient Opt-In Program, 10/09
False Claims Act Education Compliance for Federal Fiscal Year 2008, 7/09, 8/09
Federal MAC List Changes, 4/09, 5/09, 6/09 , 8/09, 9/09, 10/09
Insulin Syringes, 6/09
Medicaid Fraud and Abuse – Confidential Online Complaint Form, 4/09
Medical Risk Management Project, 3/09
New Prior Authorization Requirements for Brand-Name ACE Inhibitors,
Angiotensin Receptor Blockers, and Renin Inhibitors, 8/09
New Prior Authorization Requirements for Brand-Name Anticonvulsants, 12/09
New Prior Authorization Requirements for Brand Name Fibrates and Lovaza, 11/09, 12/09
New Prior Authorization Requirements for Brand-Name Muscle Relaxants, 7/09
New Prior Authorization Requirements for Brand-Name Nasal Steroids, 7/09
New Prior Authorization Requirements for Leukotriene Modifiers, 10/09
New Prior Authorization Requirements for Serotonin 5-HT1 Receptor Agonists (Triptans), 7/09
New Prior Authorization Requirements for Topical Anti-inflammatory Medications, 12/09
Non-Coverage of Cough and Cold Medications, 11/09
Notice of Medicaid Identification Card Changes, 8/09, 9/09
Notice of Possible Medicaid Identification Card Changes, 7/09
Over-the-Counter Medications for Skilled Nursing Facility Recipients, 2/09
Part D Drug Coverage Information, 5/09
Payment Error Rate Measurement in North Carolina, 11/09
Pharmacy Reimbursement Changes, 9/09
Prescription Origin Code, 5/09 , 6/09
Prior Authorization for Short-Acting Inhaled Beta Agonists, 9/09
Prodigy Diabetic Supplies Under the Durable Medical Equipment and Pharmacy
Programs, 10/09 , 11/09 Proposed Clinical Coverage Policies, 6/09
Provider Enrollment Packet Updates, 2/09
Provider Enrollment and Re-credentialing Fee, 9/09
Provider Exclusions, Fraud, and Abuse, 4/09
Reactivation of Lannett Prenatal Vitamins, 5/09
Reinstatement of NDCs from CMS, 6/09
Reporting Pharmacy POS Issues on the Weekend, 3/09
State Maximum Allowable Cost (SMAC) Change, 9/09
Suppliers of Medicare Durable Medical Equipment, 9/09
Synagis Pharmacy Claims for 2008/2009 Season, 5/09
Tacrolimus Added to the Narrow Therapeutic Index List, 5/09
Time Limit Overrides, 7/09
Tusso-DMR Coverage, 2/09
Undeliverable Mail, 4/09
Upcoming Medicaid Integrity Program – CMS Provider Audits, 2/09
Use of the Medicaid Provider Number After National Provider Identifier
Implementation, 4/09 Web-based Provider Enrollment Applications Available Online Beginning
August 31, 2009, 8/09
Who’s Who in North Carolina Medicaid, 12/09
