Author: Clinical Policy and Programs
In response to provider comments and questions regarding the December 2017 Special Bulletin, Billing Guidance:340B Modifiers, North Carolina Medicaid is publishing updated information regarding the use of the JG, TB and UD modifiers which are required to identify 340B drug claims.
Medicaid is now accepting Medicare crossover claims with the JG and TB modifiers. As these modifiers are not set to report or process drug rebates in NCTracks currently, providers will need to submit 340B claims with a modifier combination of JG and UD for dual eligible beneficiaries. Refer to the Centers for Medicaid & Medicaid Services (CMS) January 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) regarding the proper use of modifiers JG and TB.
Providers will continue to submit 340B drug claims with only the UD modifier when Medicaid is the primary payer. This is not a change from our current billing requirements.
Using the instructions above, providers may resubmit any 340B claims that denied for ‘invalid modifier’ for dates of service on or after Jan. 1, 2018, when the original claim was submitted with a JG or TB modifier.
Clinical Policy and Programs
DMA, 919-855-4320