Medicaid Pharmacy Providers

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Payer Sheets - Version D.0

Specifications for online claims processing/NCPDP.

B1, B2, B3 (Revised Sept. 2021)

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.

  • Medicaid Managed Care BIN, PCN, and Group for 1/1/2014 through 12/31/2018
    • BIN 003858, PCN A4, Group SANFRX
  • Medicaid Managed Care BIN, PCN, and Group 1/1/2019 through 12/31/2019 (pharmacy services carved out of managed care starting 1/1/2020)
    • BIN 610011, PCN IRX, Group SHNNDMEDI

Pharmacy Prior Authorization Info and Forms

Health Information Designs (HID) is North Dakota Medicaid's Prior Authorization VendorPer 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 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

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Additional Links


Questions? Contact Us

If you have pharmacy questions, you may e-mail them to dhsmed@nd.gov. If you have pharmacy billing questions, contact provider relations at (701) 328-7098.