SPECIAL BULLETIN COVID-19 #70: Addition of Mailing and Delivery Fees to Retail Pharmacy Claims

Thursday, April 30, 2020

Effective April 27, 2020, prescriptions for NC Medicaid and NC Health Choice beneficiaries are eligible for the addition of a mailing or delivery fee via the guidelines below. NC Medicaid encourages beneficiaries to request, and pharmacy providers to mail or deliver prescriptions to beneficiaries, during the COVID-19 pandemic to achieve better social distancing within their community. This measure should be considered for all beneficiaries but especially those that are considered at higher risk for severe COVID-19 illness (CDC definition of people considered higher risk: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html).

Pharmacies must input a Level of Service (Field 418-DI) indicator equal to 02 on the POS pharmacy claim for prescriptions that are requested by the beneficiary to be mailed. The rate of payment for this mailing fee is $1.50. Mailing of prescriptions includes those that are sent via the US Postal Service, UPS, FedEx, or other similar service.

Pharmacies must input a Level of Service (Field 418-DI) indicator equal to 06 on the POS pharmacy claim for prescriptions that are requested by the beneficiary to be hand delivered by the pharmacy provider. The rate of payment for this delivery fee is $3.00. Delivery of prescriptions includes via courier or other person-to-person delivery method to the beneficiary or their designee.

Please note:

  • Providers are limited to one mail or delivery fee, per beneficiary, per Pharmacy NPI, per day
  • No more than one delivery fee will be paid on a single claim
  • Pharmacies cannot request an emergency supply and a delivery fee on the same claim
  • Mailing and Delivery fees will be reported on the POS pharmacy response transaction in the Other Amount Paid (565-J4) Field
  • Denied pharmacy claims will not pay a mail or delivery fee
  • NC Medicaid will monitor this fee usage and may update these guidelines at any time

These changes are effective April 27, 2020 and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded by NC Medicaid.

Contact:

NC Tracks Help Desk: (800) 688-6696