Duplicate Billing of Long-Acting Reversible Contraceptive Claims, From Point-of-Sale Pharmacy Claims and Duplicated on Professional Claims
NC Medicaid Office of Compliance and Program Integrity (OCPI) has found instances where claims for long-acting reversible contraceptive (LARC) were charged twice to NC Medicaid.
This error occurred during instances when the LARC was filled by a point-of-sale pharmacy and inserted by the provider in the clinic.
- The claim would have been reimbursed at the time of dispensing to the pharmacy and should not have been claimed again upon insertion by the providers’ offices.
- Duplicate claims were identified when a claim was found to have appropriately paid as a pharmacy claim and then paid again on a professional medical claim.
- Medications ordered and paid at a pharmacy may NOT be re-billed to NC Medicaid on a professional claim.
- Professional claims should include the HCPCS code of the LARC with the amount billed as $0.00.
- Only the administration cost of the drug may be billed to NC Medicaid when the drug was procured through a point-of-sale pharmacy.
NCTracks Pharmacy Call Center: 866-246-8505