Date

MO HealthNet providers billing pharmacy claims with reimbursement issues must contact Pharmacy and Clinical Services at (573) 751-6963 prior to dispensing. Reimbursement will be reviewed and if MO HealthNet determines a pricing update is needed, it will be made effective the date of review. If additional review is necessary, the provider must submit the MAC Pricing Inquiry Worksheet. The worksheet may only be submitted when instructed by MO HealthNet and only for the drug(s) specified. The inquiry will not be reviewed if the worksheet is received incomplete, lacking the required invoice, for more or different drugs than instructed, and/or containing Protected Health Information (PHI). Upon review, providers will be notified of the outcome of the pricing inquiry. Any pricing updates will be made effective the date the pricing worksheet is received, not the day the provider called with the reimbursement issue. It is the provider's responsibility to confirm the request was received on the day it was faxed. It is imperative that the worksheet is submitted on the same day the medication is dispensed, if the provider chooses to dispense below cost. MO HealthNet providers shall make every effort to resolve reimbursement issues prior to dispensing and are not require to dispense below cost.