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Elizabeth M. Whitehorn, Director

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.

Problem:

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.

Providers Impacted:

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.

  1. 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.

  2. 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.