Emergency pharmacy claims processing for displaced Kentucky Medicaid members
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Governs pharmacy claim submission and overrides for Commonwealth of Kentucky Medicaid members displaced by widespread flooding in specified counties; affects pharmacies, prescribers, and MedImpact processing for those members.
No material clinical or coverage changes in this revision.
Emergency Claims Coverage Criteria
Emergency claim handling criteria
During the declared Kentucky emergency for the listed counties, MedImpact permits specific NCPDP values and optional fields to support claims for displaced members and to enable overrides of certain denials.
ALL of the following
- Member is displaced within the counties listed in the Kentucky emergency declaration (Bullitt, Clinton, Cumberland, Garrard, Grayson, Hart, Jackson, Jessamine, Madison, Meade, Mercer, Metcalf, Ohio, Spencer, Wayne).
ALL of the following
- Effect: permits appropriate override of certain denials for displaced members.
- Optional: NCPDP Patient Segment displaced/home address fields may be submitted to indicate the member's home address (if available): 323-CN, 324-CO, 325-CP.
- If a pharmacist is the prescriber, Prescriber Id field 411-DB may contain the pharmacist NPI with qualifier 01.
NCPDP Segments and Codes for Emergency Claims
| 323-CN | Patient Street Address / Patient City Address — the street address and city of patient's home (optional displaced address) |
| 324-CO | Patient State/Province Address — the state of patient's home (optional displaced address) |
| 325-CP | Patient Zip/Postal Zone — the zip/postal code of patient's home (optional displaced address) |
| 420-DK | Submission Clarification Code — use value 13 for emergency displacement |
| 411-DB | Prescriber Id — may contain pharmacist NPI when pharmacist prescribes; qualifier 01 is valid |
Pharmacy and Prescriber Submission Actions
Submit 420‑DK=13 and allow pharmacist NPI in 411‑DB (qualifier 01)
During the Kentucky emergency declaration pharmacies must submit Submission Clarification Code value 13 in NCPDP field 420‑DK to allow MedImpact to override certain denials for members displaced by flooding. When a pharmacist is the prescriber, the pharmacist NPI may be submitted in Prescriber Id (411‑DB) using qualifier 01.
- Use Submission Clarification Code 13 in field 420‑DK for displaced members to permit override of certain denials.
- If a pharmacist prescribes, populate Prescriber Id (411‑DB) with the pharmacist NPI and include qualifier 01.
Defined Terms and NCPDP Field Details
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