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:
- Must be employed and affiliated with a Pharmacy that is enrolled as a North Dakota Medicaid provider.
- The Pharmacy must also be participating in the Medicaid Expansion network. If the pharmacy is not, email firstname.lastname@example.org requesting to be set-up within the Medicaid Expansion network.
- The individual MTMS pharmacist must be credentialed with BCBSND.
- Utilize the Practitioner Credentialing Application, if you are not yet credentialed and need to be.
The MTMS pharmacist submitting a MTMS claim to BCBSND is required to use their individual 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.
A new requirement will be coming soon pertaining to the Medicaid provider ID number. For more information regarding this change please see the HCN titled Important Message Medicaid Expansion Claim Submission - Medicaid ID Notification-Revision. For MTMS services, the individual pharmacist will utilize the billing pharmacy Medicaid ID as their own, for claim filing purposes. Once a date for this change is determined another HCN will be published.
You can find the Medication Therapy Management Services (MTMS) (Medicaid Expansion) medical policy at bcbsnd.com.
The policy along with the Medicaid Expansion provider manual, will be updated to reflect this information as well.
*This change does not apply to Commercial members.