Effective September 21, 2020
On January 24, 2020, a bulletin was issued by the U.S. Department of Health and Human Services (HHS) informing stakeholders of a final rule which made a regulatory change under the Health Insurance Probability and Accountability Act of 1996 (HIPAA) and also modifying the requirements for use of the National Council for Prescription Drug Programs (NCPDP) Telecommunication Standard Implementation Guide, Version D, Release 0, August 2007, by requiring the use of the Quantity Prescribed (460-ET) field to identify partial fills for Schedule II medications. This modification is being enabled to help prevent prohibited refills of Schedule II medications and to help researchers enhance their understanding of prescribing trends. The final rule can be found here in its entirety.
Effective July 1, 2020, the Montana Healthcare Programs NCPDP Payer Sheet will be updated to reflect the required field. However, it will not be required for pharmacies to start populating the field (460-ET) in claim submissions until September 21, 2020. Therefore, we encourage pharmacies to work with their software vendor. Claims will deny starting on this date if the field is not populated on the claim for CII prescriptions only. Montana Healthcare Programs will only be requiring the field be populated and the number in the field is a valid numeric number, greater than zero.
Pharmacies can expect to see a reject code of “M/I Quantity Prescribed” if the field is blank, has all zeros, or is missing in the claim submission on CII prescriptions only.
For questions regarding this policy, please contact Shannon Sexauer, PharmD, Medicaid Pharmacist, at (406) 444-5951 or Dani Feist, Pharmacy Program Officer, at (406) 444-2738.
Contact Information
Drug Prior Authorization Unit
Mountain-Pacific Quality Health
3404 Cooney Drive
Helena, MT 59602
(406) 443-6002 or (800) 395-7961 (Phone)
(406) 513-1928 or (800) 294-1350 (Fax)
For claims questions or additional information, contact Montana Provider Relations at (800) 624-3958 or (406) 442-1837 or email MTPRHelpdesk@conduent.com.
Visit the Montana Healthcare Programs Provider Information website at https://medicaidprovider.mt.gov.