Current through Register Vol. 24-18, September 15, 2024
(1) When billing the medicaid agency for
pharmacy services, providers must:
(a) Use the
appropriate agency claim form or electronic billing specifications;
(b) Include the actual 11-digit national drug
code (NDC) number of the product dispensed from a rebate eligible
manufacturer;
(c) Bill the agency
using metric decimal quantities which is the National Council for Prescription
Drug Programs (NCPDP) billing unit standard;
(d) Meet the general provider documentation
and record retention requirements in WAC
182-502-0020; and
(e) Maintain proof of delivery receipts.
(i) When a provider delivers an item directly
to the client or the client's designee, the provider must be able to furnish
proof of delivery, including the signature of either the client, the client's
designee, or the provider, the client's name, and a detailed description of the
item or items delivered.
(ii) When
a provider mails an item to the client, the provider must be able to furnish
proof of delivery including a mail log.
(iii) When a provider uses a delivery or
shipping service to deliver items, the provider must be able to furnish proof
of delivery and it must:
(A) Include the
delivery service tracking slip with the client's name or a reference to the
client's package or packages; the delivery service package identification
number; and the delivery address.
(B) Include the supplier's shipping invoice,
with the client's name; the shipping service package identification number; and
a detailed description.
(iv) Make proof of delivery receipts
available to the agency upon request.
(2) When billing drugs under the expedited
authorization process, providers must insert the authorization number, which
includes the corresponding criteria code or codes in the appropriate data field
on the drug claim.
(3) Pharmacy
services for clients on restriction under WAC
182-501-0135 must be prescribed
by the client's primary care provider and are paid only to the client's primary
pharmacy, except in cases of:
(a)
Emergency;
(b) Family planning
services; or
(c) Services properly
referred from the client's assigned pharmacy or physician/ARNP.
11-14-075, recodified as §182-530-5000, filed
6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.04.050,
74.08.090,
74.09.530, and
74.09.700. 07-20-049, §
388-530-5000, filed 9/26/07, effective
11/1/07.
