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Related article: DUPLICATE CLAIM PROCESSING The system will use the following standard methodology to determine Duplicate paid claims: Response Status: D (retransmission NCPDP Duplicate Response) Match on: Pharmacy ID (NCPDP field # 201-B1), RX # (NCPDP field #402-D2), Patient ID (NCPDP field #302-C2), NDC (NCPDP field #407-D7), DOS (NCPDP field #401-D1) and New/Refill Code (NCPDP field #601-57) Error 83: Duplicate RX Match on: Pharmacy ID (NCPDP field # 201-B1), RX # (NCPDP field #402-D2), Patient ID (NCPDP field #302-C2), GSN (Not on claim; FDB) and DOS (NCPDP field #401-D1) Error: 83: Different Pharmacy Search Match on: RX # (NCPDP field #402-D2), Patient ID (NCPDP field #302-C2), GSN (Not on claim; FDB) and DOS (NCPDP field #401-D Error 83: Duplicate Fill Match on: Patient ID (NCPDP field #302-C2), GSN (Not on claim; FDB) and DOS (NCPDP field #401-D1) DISPENSING LIMITS: Days Supply: There is a per claim days supply maximum of 34 days. Quantity dispensed should be commensurate to the days supply. Exceptions: Maintenance drugs allow 102 days supply REFILLS A maximum of 11 refills for Non-Controlled Covered Drugs. Refills are not allowed on non-controlled drugs to be filled 360 days or more from the date prescribed. A maximum of 5 refills for Schedules III, IV and V controlled covered drugs. Refills are not allowed on controlled drug to be filled 180 days or more from the date prescribed. The system will not allow refills for Schedule II controlled covered drugs PRICING ACS will ensure the claims reimburse at the following pricing: Lesser of: - U & C - Allowable Cost + dispensing fee Allowable Cost: Lesser of: 1. IDC 2. EAC (lesser of): WAC+8%� Direct+8%� AWP - 12% 3. FUL COPAYS: There are no copays for BCCDT recipients DISPENSING FEE: BCCDT has the following dispensing fee structure: * BRAND products = $2.69 * Generic Products = $3.69 * Partial Fill dispensing fee will be paid ? at the initial fill and ? at the completion fill PRIOR AUTHORIZATION Prior Authorization requests will be handled either by Clonazepam 05mg Tab the BCCDT office or at the ACS Technical Call Center. Below is a list prior authorizations that are handled Clonazepam 05mg Tab by each entity: ACS Technical Call Center: The ACS Call Center will handle the following prior authorization requests on behalf of MD BCCDT: Maximum dollar limit > $2500.00 Early Refill Brand Medically Necessary - DAW 1, with exceptions Day Supply for approved situations PA denials handled by ACS will return the following message text in the response: �Prior Authorization Required, Call ACS at 1-800-932-3918 (24/7/365)�. BCCDT Office: The MD BCCDT staff will handle the following prior authorization requests: * Early Refill - For requests outside established criteria * PA/Medical Certification - authorization based on diagnosis * DME/DMS for HCFA 1500 billing - exception: needles, syringes that are paid through POS PA denials handled by MD BCCDT will return the following message text in the response: �Prior Authorization Required, call MD BCCDT (410) 767-6787, M-F, 8:30 am � 4:30 pm�. DRUG COVERAGE Drug Coverage is defined by the BCCDT program and its parameters. BCCDT covers drugs that are related to breast or cervical cancer diagnosis Clonazepam 05mg Tab or treatment or complications of treatment. Below is a grid of covered drugs for all groups active on the Date of Service (DOS) with BCCDT some of these drugs may require prior authorization based on diagnosis and/or medical documentation: Drug Code Drug Name Comments H3A Analgesics, Narcotics H3D Analgesics, Salicylates Oral forms only covered H3E Analgesics/Antipyretics, Non-Salicylates Oral forms only covered H6J Anti-emetics
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