DCH Releases Updated Pharmacy Services Provider Manual with New Requirements for 340B Claims

InsightsClient Alert

Recently, the Department of Community Health (DCH) published an updated Pharmacy Services Provider Manual with additional billing instructions for all 340B drug claims. DCH used this update to consolidate prior guidance and provide additional information on 340B Program participation and prevention of duplicate discounts.

For 340B Outpatient Pharmacy (Retail Pharmacy) Claims, DCH now requires an additional clarification code for 340B-purchased drugs of “08” in the basis of cost determination field 423-DN. This is in addition to the previously required submission clarification code of “20”.

As previously communicated in a DCH provider message in February 2018, DCH will also require a UD billing modifier for 340B-purchased drugs billed on a UB-04 or CMS Form 1500 effective July 1, 2018. This change in practice means DCH will no longer rely exclusively on the Medicaid Exclusion File to prevent duplicate discounts.

The changes apply to both FFS Medicaid and CMO claims.

For full instructions related to billing Georgia Medicaid 340B claims, see Chapter 607 in the April 2018 Pharmacy Services Provider Manual, located here.

The contact information provided for Georgia’s Medicaid policy on the 340B program is 340B@dch.ga.gov.

If you have questions or need assistance understanding the implications of this new requirement, please contact our Albany office at (229) 883-7878.