DCH to require claim-level modifiers for 340B drug claims starting July 1, 2018

Insights340B Newsletter, Client Alert

Recently, the Department of Community Health (DCH) released billing instructions for Hospital 340B drug claims submission effective July 1, 2018.  This change means that the Medicaid Exclusion File will no longer be exclusively used by DCH to prevent duplicate discounts, one of the statutory requirements of the 340B Program.

Here is what you need to know:

  • DCH will require additional identifiers at the claims submission level for all 340B drug claims.
  • Claims that include 340B-purchased drugs must be submitted on a UB-04 or CMS 1500 claim form using the following claim identifiers: HCPCS code, UD Modifier, and National Drug Code (NDC). If the product is not 340B eligible, do not include the UD Modifier.
  • Hospitals wishing to change their decision on whether to carve-in or carve-out should do so before June 15, 2018 for the change to take effect in the Medicaid Exclusion File July 1, 2018 (HRSA FAQ 1507).
  • All claims may be subject to audits to confirm compliance with this new DCH policy.

The link to the policy notice can be found on Georgia Medicaid Management Information System’s (GAMMIS) portal by filtering on 2018 Provider Messages and then searching keywords “billing instructions for 340B.” https://www.mmis.georgia.gov/portal/PubAccess.Provider%20Information/Provider%20Messages/tabId/55/Default.aspx

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

If you need assistance in reviewing your 340B Program, please contact our Albany office at (229) 883-7878 or our Atlanta office at (404) 220-8494.