CurrentDenver-Health-Medical-PlanPolicy N/A

340B Drug Products — Claim Identification and Submission

Governs how contracted pharmacy providers for Denver Health Medical Plan must identify and submit claims for 340B drug products, and the responsibilities and risks associated with incorrect claim submission.

Policy Summary

PayerDenver-Health-Medical-Plan

Policy340B Drug Products — Claim Identification and Submission

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionAt point of sale, submit Submission Clarification Code value 20 in field 420-DK for 340B claims; if discovered later, reverse and resubmit with SCC=20.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20SCC value required for 340B

NCPDPReport 340B location to

017142BIN for Elevate Medicaid Choice

DHM02Processor Control Number

340B Claim Processing Rules

340B claim processing criteria

Rules for processing and correcting 340B claims:

At point of sale, contracted pharmacies must submit Submission Clarification Code (SCC) = 20 in field 420-DK to identify 340B drug products.

If a pharmacy is notified or discovers after adjudication that a claim qualifies as 340B, the original claim must be reversed and resubmitted with SCC=20.

Pharmacies are requested to confirm or report their physical location 340B status to the National Council for Prescription Drug Programs (NCPDP) to assist identification and avoid duplicate discounts.

Failure to include the correct SCC may put the pharmacy and eligible entity at risk for duplicate discounts and may be treated as a potential breach of contract subject to administrative or corrective action up to and including termination of the DHMP contract.

Submission Clarification Code and Billing Fields

Policy Summary

PayerDenver-Health-Medical-Plan

Policy340B Drug Products — Claim Identification and Submission

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionAt point of sale, submit Submission Clarification Code value 20 in field 420-DK for 340B claims; if discovered later, reverse and resubmit with SCC=20.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Required Actions for Pharmacies and Claim Corrections

Billing Rule

Submit SCC=20 at point of sale; reverse & resubmit if discovered later

At point of sale, contracted pharmacy providers must submit Submission Clarification Code value of 20 in field 420-DK; if a claim is later discovered to qualify as 340B, the original claim must be reversed and resubmitted with SCC=20.

Submit SCC=20 in field 420-DK at point of sale per Social Security Act citation.
If notified or if discovery occurs after adjudication that the claim qualifies as 340B, reverse the original claim and resubmit with SCC=20.

Documentation Required

Report physical-location 340B status to NCPDP

Pharmacies are requested to confirm or report their physical location 340B status to the National Council for Prescription Drug Programs (NCPDP) to assist identification of 340B claims and avoid duplicate discounts.

Reporting physical location 340B status to NCPDP helps identify 340B claims and increase compliance with duplicate discount avoidance.

OpenPayer

340B Drug Products — Claim Identification and Submission

340B Claim Processing Rules

Submission Clarification Code and Billing Fields

Required Actions for Pharmacies and Claim Corrections

Key Terms