Pharmacy Claims for OTC Items

February 2, 2012

On Tuesday January 24, the Pharmacy POS was updated to the new HIPAA compliant D.0 version of the point of sale system. With the upgrade, we have added certain features. For example, pharmacies can now bill multiple line compounds electronically and do reversals on line.
In addition, the new system was designed to deny claims automatically for certain OTC items that are to go to a nursing home or an ICF-MR. Under section 60 of MaineCare policy, there is a list of OTC and other DME items that are not billable by a NH or an ICF-MR. This feature would prevent these claims from going through the pharmacy and assure that the pharmacies charge appropriately.
Unfortunately, the system can’t distinguish between one of these facilities and an assisted living facility. So at this time we have had to shut this edit off. We are working to fix this and will send an update as soon as we have one. Pharmacies are responsible to bill according to policy.

If you have questions about this, feel free to contact Pharmacy Provider Services help desk at 1-888-420-9711.