Claims : Submission

Repackaging

Pharmacy providers dispensing medications using member compliance aid packaging (e.g., blister packaging) are required to relabel unused quantities when the drug regimen is changed.

To indicate that repackaging has occurred for non-unit dose oral drugs in a solid form, pharmacy providers are required to indicate the appropriate code in the Special Packaging Indicator field. Any other valid value indicated in the special packaging indicator field will not be used to determine reimbursement for repackaging.

If the appropriate code is indicated on the Special Packaging Indicator field for an oral drug in a solid form that is not packaged by the manufacturer in individual unit doses, ForwardHealth will add $0.015 per unit billed to the professional dispensing fee for repackaging.

On claims for which the special packaging indicator is invalid, providers will receive an EOB code.