Important Notification Regarding Medication Therapy Management Services (MTMS) for Medicaid Expansion Members*

Effective January 1, 2023, Blue Cross Blue Shield of North Dakota (BCBSND) implemented a medical policy specific to Medicaid Expansion for Medication Therapy Management Services (MTMS) provided by MTMS pharmacists through the medical benefit.
Prior to submitting MTMS claims for procedure codes 99605, 99606 and 99607, the MTMS pharmacist:

  1. Must be enrolled as a North Dakota Medicaid provider
  2. Must be credentialed with BCBSND
  3. Must email requesting to be set up as a Medicaid Expansion provider.

The MTMS pharmacist submitting an MTMS claim to BCBSND is required to use their individual National Provider Identifier (NPI) as the performing provider and the pharmacy NPI as the billing provider. Claims received with the pharmacy NPI listed as the performing provider will be rejected.

Find the Medication Therapy Management Services (MTMS) (Medicaid Expansion) medical policy online.

*This change does not apply to Commercial members.