Kentucky Medicaid has activated the emergency service to allow the appropriate submission clarification code to override certain denials for members impacted by the tornadoes on Dec. 10, for the following counties: Fulton, Hickman, Graves, Marshall, Lyon, Caldwell, Hopkins, Muhlenberg, Ohio and Hancock. If an affected member presents at a pharmacy for a refill and identifies as an affected member, the pharmacist will have the capability to use the Submission Clarification Code (420-DK) = 13 to indicate Payer-Recognized Emergency/Disaster Assistance Request - The pharmacist is indicating that an override is needed based on an emergency/disaster situation recognized by the payer. This override will allow pharmacy providers to override claims denials for early refill and accumulated quantity edits only. All other edits will remain in place including prior authorization and eligibility.
NCPA
