PACE

PROVIDER BULLETIN

April 21, 2006

Date the Prescription is Written Edit

Questions

 

Effective February 28, 2006, the Date the Prescription is written is compared against the “Date of Service” on original and refilled prescriptions.  Original or refill prescriptions whose date of service exceeds 6 months from the date the prescription was written deny with an NCPDP Error M4, PACE Error 724, “Prescription Time Limit Exceeded.”

 

1. Question:  I have a prescription for a PACE cardholder that was written on December 1, 2005 with 5 refills. The first fill was on February 1st.  If this cardholder gets this medication refilled every month, her July refill will deny because more than 6 months have passed even though her physician said the prescription had 5 refills. Is this correct?

    Answer: Yes.

 

2. Question: What do I do then? The prescriber said the prescription had 5 refills. There are refills left. Can I just assign a new prescription number?

    Answer:  No. Assigning a new prescription number won’t permit the claim to process since the date the prescription was written remains the same.

 

3. Question: Then the prescriber is to be contacted to renew the prescription, even though the prescription still has refills left?

    Answer: Yes. The life of the prescription is 6 months. When contacted, the physician:

 

4. Question:  Almost the same situation as question 1. Except, the prescription written on December 1, 2005 with 5 refills was for an A-rated brand and had “Brand Medically Necessary” handwritten on it. The 4th refill is in July and denies because more than 6 months have passed even though her physician said the prescription had 5 refills. Can I call the prescriber for a continuation?

Answer: Yes, IF the prescription with the remaining fills can be referenced to the original prescription on audit. That is, the prescriber is to be called and authorization received for the continuation of the refills. The new prescription will be identified as a “telephone” prescription. On audit the 4th or 5th refill claim will be disallowed UNLESS the new prescription with the remaining refills from the original prescription can be referenced. 

Note: after the final refill of the original prescription, a new handwritten prescription will be needed if the prescriber wants to continue the cardholder on the same prescription regimen.

 

Questions should be directed to Provider Services at

1-800-835-4080.