Billing and Policy Information for Providers

Questions about billing and policy issues related to pharmacy services should be directed to the Pharmacy Program at (334) 242-5050 or (800) 748-0130 x2020.

• DAW Code 9 List - Effective 10/1/24
• DAW Code 9 List - Effective 1/2/25
• Hospice Palliative Drug List
• Appropriate Utilization of Dispense as Written Codes - Updated 8/3/22
• Maximum Quantity Listing - Effective 10/1/24
• Maximum Quantity Listing - Effective 1/2/25
• NDC Requirements for Physician-Administered Medications - Updated 1/14/21
• DUR Outcome Reject Codes
• Other Coverage Codes - Third Party - Updated 1/14/21
• Pharmacy Audit Components
• Special Instructions for Pharmacies - When recipient has both Medicaid and Point-of-Sale Drug Plan
• Recipient Denial Information Form - Effective 9/1/13 
• Compound Claims - Updated 10/11/24
• Usual and Customary ALERT - 10/26/06
• Usual and Customary Electronic Claims ALERT - 3/31/10
• Reminder Usual and Customary ALERT -  8/1/19

• Drug Look Up - Access and retrieve drug specific information
• CMS Drug Product File (includes Covered Outpatient Drug Status)  - Product Data for Drugs in the Medicaid Drug Rebate Program
• Administrative Code - Chapter 16
• Provider Manual - Chapter 2 - Enrolling in Medicaid
• Provider Manual - Chapter 27 - Pharmacy
• Physician Drug Fee Schedule
• Checklist for Pharmacy - Information on denials, reasons for recoupments, where to find information in the Medicaid Provider Billing Manual, free tools and contacts for providers to use in preventing fraud and abuse - 9/17
• Provider Alerts