On August 19, 2018, the MO HealthNet Division (MHD) will implement a maximum daily quantity edit. This quantity limit is based upon the maximum number of units of the drug allowed per day as determined by the MHD or First Databank’s (FDB) MedKnowledge. The correct day's supply must be submitted on drug claims based on the quantity dispensed and the directions as written by the prescriber. Claims submitted for a quantity above the maximum daily units will deny.
This edit will help ensure claims integrity and the accuracy of data transmitted on claims submitted to the MHD. Billing errors caused or committed by the provider or their employees, including but not limited to incorrect ingredient indicators, quantities, day’s supply, prescriber identification, dates of service, and usual and customary charges, are subject to adjustment or recoupment. For questions regarding billing or denied claims, providers may contact Pharmacy and Clinical Services at (573) 751-6963.
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