Payer Sheets - Version D.0
Specifications for online claims processing/NCPDP.
B1, B2, B3, E1 (Revised April 2023)
Instructions for 340b pharmacies are within the payer sheet. 340b contract pharmacies must carve out ND Medicaid. For Medicaid Managed Care, providers are not allowed to use 340b products. Pharmacy services are carved out of managed care starting January 1, 2020.
Pharmacy Prior Authorization Info and Forms
Acentra Health is North Dakota Medicaid's Prior Authorization Vendor. Per federal law, state Medicaid programs may require, as a condition of coverage or payment for a covered outpatient drug, the prior approval of the drug before it is dispensed for any medically accepted indication.
The 2003 Legislative Assembly passed House Bill 1430. This restructured the existing Drug Use Review (DUR) Board and required the Board to advise the Department of Health & Human Services in developing a Prior Authorization (PA) process to help assure that beneficiaries receive appropriate medications in the most cost-effective manner, thus conserving state expenditures for drugs whenever possible.
Questions? Contact Brendan Joyce, PharmD, Administrator, Pharmacy Services at bjoyce@nd.gov .
Drug Rebate Program
Resources
- Pharmacy Medical Billing Manual (July 2023)
- Pharmacy Provider Manual (January 2023)
- Drug Use Review Board
- DME Fee Schedules
Additional Links
- Visit: website ND Board of Pharmacy
- Visit website: Centers for Medicare and Medicaid Services: Medicaid Prescription Drug
Questions? Contact Us
If you have pharmacy questions, you may e-mail them to medicaidpharmacy@nd.gov. If you have pharmacy billing questions, contact provider relations at (701) 328-7098.