340B Dispensing Fee Add-On for Provider Type 52
HFS System Issue:
The 340B dispensing fee add-on is not being applied to claims submitted by Provider Type 52, Local Health Department.
The department released a notice on February 4, 2014 informing providers that in order to receive the $20 dispensing fee add-on, providers must identify 340B purchased drugs by reporting modifier “UD” in conjunction with the appropriate procedure code. Effective immediately, the provider charge should be the actual acquisition cost plus the $20 dispensing fee. On April 16, 2014, department staff were informed that the programming logic for the Local Health Departments was not programmed into the claims processing system.
Local Health Departments
Procedure Codes Impacted:
Any procedure code for a 340B purchased drugs reported with the modifier “UD”.
Problem Begin Date:
Claims received 02/04/2014 and after
Problem Fix Date:
May 23, 2014
Resolution for Impacted Claims:
Providers may submit a void & rebill or a replacement claim. The department will accept electronic transactions submitted through MEDI or via 837P files to void or replace a payable or pending-payable claim if submitted within 12 months from the original paid voucher date.
Replacement claims – To replace a single service line or entire claim, enter Claim Frequency “7.” Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide. This method is preferred as it requires no manual override.
Void & Re-bill – This process involves two steps. The void portion may be completed electronically or on paper. Please refer only to step #1 for a void with no re-bill.
To electronically void a single service line or an entire claim, enter Claim Frequency “8.” Detailed instructions on how to void a claim electronically can be found in the Chapter 300, 837P Companion Guide. A paper void may be completed by submitting a NIPS Adjustment Form HFS 2292, Instructions for which may be found in Chapter 100, Appendix 6.
Following completion of the void, a new original claim must be submitted within 90 days of the void DCN and may require manual override. If manual override is required, attach to a paper claim: a cover letter stating the reason for request for timely filing override.