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December 13, 2006

Medicaid Information Release #MA06-44

TO:             Pharmacies

FROM:       Leslie M. Clement, Administrator

SUBJECT:  PHARMACY BILLING WHEN MEDICAID IS NOT THE PRIMARY PAYER

Effective 1/1/07, pharmacies will be required to inform Medicaid when any third party payer, including Medicare, has paid on a claim including when billing for co-pay amounts.  The other insurance payment should be indicated on the claim in the appropriate field.

For claims submitted electronically, use the "Other COB (Coordination of Benefit)" fields to specify carriers, insurance payments, any Adjustment Reason Codes (ARCs) plus any further information as applicable.  For claims submitted on paper, make sure you fill in the "Other Insurance Amount" on the claim form and attach the other insurance EOB.

If you have any questions concerning the information contained in this release, please contact Sheila Pugatch, Principal Financial Specialit for the Office of Reimbursement Policy, at (208) 364-1817.

LMC/sp