Prescribed Drugs Provider Manual - Iowa Department of Human ...

IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage94DateAugust 1, 2013E. BILLING SYSTEMIowa Medicaid Enterprise provides for on-line, real-time processing of Medicaidpharmacy claims. Through electronic submission, you are able to submit claimsmore accurately. You also receive your Medicaid payments sooner than if yousubmitted paper claims.Point-of-sale (POS) transactions are handled by the Iowa Medicaid EnterprisePharmacy Point of Sale (POS) Unit. POS will handle the overrides for prospectivedrug utilization review edits such as high dose, therapeutic duplication, refill toosoon, excessive days supply, dose consolidation, duplicate claim, orimmunosuppressant drugs.Providers that wish to exercise the point of sale billing option must complete theIowa DHS Point of Sale Agreement. Please visit www.iowamedicaidpos.com tocomplete this agreement. You may call the (Point of Sale) POS Helpdesk at877-463-7671 or locally at 515-256-4608.1. Point of Sale Claim SubmissionFor point-of-sale (POS) submitters, refer to your POS Payer Sheet for claimsubmission instructions explanation of the data fields for the electronic billingformat. (To view the instruction on line, click here.)The Iowa Medicaid Enterprise eliminated the procedure of paying pharmacyclaims and then billing the primary insurance company on behalf of themembers (“pay and chase”) effective January 16, 2007, except for childrenunder age 21 and pregnant women.♦ For members under age 21, pharmacy claims may be processedthrough Pharmacy Point of Sale System with Iowa Medicaid as theprimary insurer.♦ For members who are pregnant, bill claims through the PharmacyPoint of Sale System with Iowa Medicaid as the primary insurer. To get a$0.00 copayment:• Enter code “2” (medical certification) in the prior authorization typecode field (NCPDP field 461-EU), and• Enter code “4” in the Prior Auth Number Submitted (NCPDP field462-EV).