NOTE:
To ensure claims processing of procedure codes 99605, 99606 and 99607, the MTMS pharmacist provider must be credentialed with Blue Cross Blue Shield of North Dakota (BCBSND) and 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.
NOTE:
Medicaid Expansion (ME) members who are also Medicare eligible are not eligible for MTMS.
NOTE:
ME members who reside in a setting where medications are managed/administered by facility staff (e.g., inpatient, incarcerated, skilled nursing facility, etc.) are not eligible for MTMS.
NOTE:
The place of business where face-to-face MTMS pharmacist encounters (in-person or virtually with real-time audio and visual conferencing) are provided must:
-
Be located within the state of ND or the local trade area within 50 miles of the ND border;
and
-
Have appropriate size and accommodations for services provided;
and
-
Prevent the encounter from being heard and/or seen by others;
and
- Prevent interference by distracting noise from other areas of the business.
NOTE:
All written and verbal contact must be documented in an individual's electronic MTMS records. BCBSND does not require a certain documentation platform be used. Group visits, preparation time, no-show appointments, follow-up or reminder calls and the time required to document the MTMS encounter are not billable. The electronic documentation platform used must:
-
Allow manual entry of individuals;
and
-
Be designed to optimize therapeutic outcomes;
and
-
Be able to track and report interventions and outcomes (within five (5) business days when requested by BCBSND);
and
- Maintain records in accordance with HIPAA requirements and other state and federal regulations.
The MTMS pharmacist provider must provide the following communication within seven (7) days of MTMS:
-
An individual visit summary to the individual which includes a personal medication list and information on what was discussed during the MTMS encounter;
and
- Outreach to applicable primary care and specialist providers if needed.
