NOTE: The MTMS pharmacist provider must be credentialed with Blue Cross Blue Shield of North Dakota (BCBSND) and enrolled as a North Dakota Medicaid provider to ensure claims processing of procedure codes 99605, 99606 and 99607.
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.
