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  • Pharmacy Claim Denial Issue Resolved: We have resolved the issue in which a small percentage of pharmacy claims were denied inappropriately. Providers with impacted claims received one of these explanation of benefits codes:
    • 0100, "Denied as a duplicate claim. Services on this claim were previously partially paid or paid in full."
    • 0114, "Schedule 3, 4, 5 drugs limited to original fill plus 5 refills or 6 months."
    • 0146, "Non-scheduled drugs limited to original dispensing plus 11 refills or 12 months."
    • 9999, "Processed per policy."
    Pharmacy providers may now resubmit pharmacy claims that were inappropriately denied.

Pharmacy

Resources Supporting Coverage of Over-the-Counter Oral Contraception Under State Standing Orders

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