Magellan Medicaid Administration || Client Portal

340B Information

Item	Last Modified
340B Cover Letter	02/23/2022
340B FAQs	02/23/2022
340B Non-participation Notice Form	02/23/2022
340B Participation Notice Form	02/23/2022

Manuals

Item	Last Modified
Pharmacy Provider Billing Manual	01/19/2022
Trading Partners FTP Instructions	05/29/2018
MEUPS Provider Sign-in Instructions	06/25/2014
Web Claim Submission (WCS) User Guide	06/27/2014

Payer Specs

Item	Last Modified
D.0 Payer Specs	08/27/2020

Drug Lists

Item	Last Modified
Diabetic Supply Preferred Drug List (effective 07/07/2022)	07/07/2022

Contacts

Prior Authorization
1-800-477-3071
Claim Inquiry
1-800-432-7005

Please note questions regarding claims prior to October 5, 2010 should be directed to 1-800-807-1232.

Provider Notices

Title	Description	Last Modified
Pharmacy Provider Notice #274	Quantity Limits added to Disposable Diabetic Pumps and Components and Criteria for Continuous Glucose Meters (CGMs)	06/06/2022
Pharmacy Provider Notice #272	New Omnipod NDCs Added to the Diabetic Supply List	05/04/2022
Pharmacy Provider Notice #258	September 2021 PDL and Diabetic Supply List Changes	11/02/2021
Pharmacy Provider Notice #253	BD Diabetic Supplies	03/24/2021
Pharmacy Provider Notice #249	Diabetic Supplies	12/01/2020

Drug Management Review Advisory Board

Item	Last Modified
Information about the Drug Management Review Advisory Board	External URL

General Information

Drug Information

Item	Last Modified
Covered Prescription Cold, Cough, and Vitamin Product List	current
Injectable Drug List	current
Maximum Quantity Limits List	current
Over-The-Counter (OTC) Drug List	current
Preferred Drug List (PDL)	current
Prior Authorization (PA) Criteria	current
Single PDL Provider FAQ	External Link
Single PDL Member FAQ	External Link

Maximum Allowable Cost

Title	Last Modified
Maximum Allowable Cost (MAC) list	Monthly Update
Maximum Allowable Cost (MAC) Listing - (Weekly Changes)	Wednesday Update
MAC Price Research Request Form	09/02/2021

Education

Title	Description	Last Modified
NCPDP D.0 FAQs	Kentucky Medicaid's Frequently Asked Questions	11/14/2011

NCPDP Resources

Title	Description	Last Modified
https://www.ncpdp.org	NCPDP Website - To purchase implementation guides and access technical questions	11/11/2010

CMS Resources

Title	Description	Last Modified
https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Versions5010andD0	CMS Website - Central Version 5010 and D.0 Webpage	04/28/2021
http://www.cms.gov/MFFS5010D0	CMS Website - Dedicated HIPAA 5010/D.0 Project Web Page	11/11/2010

Current Notices

Title	Description	Notice Date
Fee-for-Service Pharmacy Provider Notice #276	May 2022 P&T PDL Changes	07/01/2022
Fee-for-Service Pharmacy Provider Notice #275	Generic Truvada Criteria Removal	06/06/2022
Fee-for-Service Pharmacy Provider Notice #274	Quantity Limits Added to Disposable Pumps and CGMs	06/06/2022
Fee-for-Service Pharmacy Provider Notice #273	Lidoderm Shortage Leads to Temporary PDL Changes	05/06/2022
Fee-for-Service Pharmacy Provider Notice #272	New Omnipod NDCs Added to the Diabetic Supply List	05/04/2022
Fee-for-Service Pharmacy Provider Notice #271	March 2022 PDL Changes	05/02/2022
Fee-for-Service Pharmacy Provider Notice #270	MetroCream Shortage	04/25/2022
Fee-for-Service Pharmacy Provider Notice #269	Injectable Drug List	04/04/2022
Fee-for-Service Pharmacy Provider Notice #268	Physician Protocol for COVID-19 Test Kits	02/01/2022
Fee-for-Service Pharmacy Provider Notice #267	COVID-19 Home Test Kits	01/28/2022
Fee-for-Service Pharmacy Provider Notice #266	Brand/Generic Switches	01/25/2022
Fee-for-Service Pharmacy Provider Notice #265	Brand/Generic Reversal	01/14/2022
Fee-for-Service Pharmacy Provider Notice #264	Zoloft Oral Concentrate Update	01/05/2022
Fee-for-Service Pharmacy Provider Notice #263	November 2021 PDL and OTC List Changes	01/03/2022
Fee-for-Service Pharmacy Provider Notice #262	Trulicity/Ozempic Switch	12/21/2021
Fee-for-Service Pharmacy Provider Notice #261	Zoloft Oral Concentrate	12/16/2021
Fee-for-Service Pharmacy Provider Notice #260	Antidepressants	12/14/2021
Fee-for-Service Pharmacy Provider Notice #259	Emergency Declaration Early Refill Bypass	12/13/2021
Fee-for-Service Pharmacy Provider Notice #258	September 2021 PDL and Diabetic Supply List Changes	11/02/2021
Fee-for-Service Pharmacy Provider Notice #257	May 2021 PDL Changes	07/01/2021
Fee-for-Service Pharmacy Provider Notice #256	Senate Bill 51 and Support Act	06/11/2021
Fee-for-Service Pharmacy Provider Notice #255	OTC Drug List Update	06/01/2021
Fee-for-Service Pharmacy Provider Notice #254	March 2021 PDL Changes	05/01/2021
Fee-for-Service Pharmacy Provider Notice #253	BD Diabetic Supplies	03/24/2021
Fee-for-Service Pharmacy Provider Notice #252	COVID-19 Vaccine Updated Fees	03/23/2021
Fee-for-Service Pharmacy Provider Notice #251	November 2020 PDL Changes	01/22/2021
Fee-for-Service Pharmacy Provider Notice #250	COVID-19 Vaccine	01/04/2021
Fee-for-Service Pharmacy Provider Notice #249	Diabetic Supply Changes	12/01/2020
Fee-for-Service Pharmacy Provider Notice #248	Single PDL Changes	11/06/2020
Fee-for-Service Pharmacy Provider Notice #247	September 2020 PDL Changes	11/06/2020
Fee-for-Service Pharmacy Provider Notice #246	NCPDP Quantity Prescribed Update	09/02/2020
Fee-for-Service Pharmacy Provider Notice #245	May 2020 PDL Changes	07/23/2020
Fee-for-Service Pharmacy Provider Notice #244	Brand/Generic Switches	05/07/2020
Fee-for-Service Pharmacy Provider Notice #243	Presumptive Eligible Members	05/07/2020
Fee-for-Service Pharmacy Provider Notice #242	Reimbursement Error for Brand over Generic Products	03/26/2020
Fee-For-Service Pharmacy Provider Notice #241	COVID-19 Emergency Signature Log Change	03/26/2020
Fee-for-Service Pharmacy Provider Notice #240	November 2019 PDL Changes	01/27/2020
Fee-for-Service Pharmacy Provider Notice #239	340B Procedures	12/19/2019
Fee-for-Service Pharmacy Provider Notice #238	September 2019 PDL Changes	11/07/2019
Fee-for-Service Pharmacy Provider Notice #237	Pharmacy License Update Reminder	07/19/2019
Fee-for-Service Pharmacy Provider Notice #236	May 2019 PDL Changes	07/19/2019
Fee-for-Service Pharmacy Provider Notice #235	March 2019 PDL Changes	05/06/2019
Fee-for-Service Pharmacy Provider Notice #234	Updated Buprenorphine-Naloxone PA Waiver	03/04/2019
Fee-for-Service Pharmacy Provider Notice #233	November 2018 PDL Changes	02/06/2019
Fee-for-Service Pharmacy Provider Notice #232	September 2018 PDL Changes	01/03/2019
Fee-for-Service Pharmacy Provider Notice #231	Buprenorphine PA Waiver	10/11/2018
Fee-for-Service Pharmacy Provider Notice #230	Opioid Class Criteria Changes	09/04/2018
Fee-for-Service Pharmacy Provider Notice #229	May 2018 PDL Changes	09/04/2018
Fee-for-Service Pharmacy Provider Notice #228	Pharmacy License Update Reminder	09/04/2018
Fee-for-Service Pharmacy Provider Notice #227	Opioid Class Criteria Changes	06/15/2018
Fee-for-Service Pharmacy Provider Notice #226	March 2018 PDL Changes	06/15/2018
Fee-for-Service Pharmacy Provider Notice #225	November 2017 PDL Changes	06/01/2018
Fee-for-Service Pharmacy Provider Notice #224	May 2017 PDL Changes	06/01/2018

Title	Last Modified
Universal PA Request Form – All Others	10/07/2021

For telephonic prior authorization requests or inquiries regarding a prior authorization please call (800) 477-3071.

Please fax prior authorization requests to one of the following numbers —

Regular Fax Line:

800-365-8835

Urgent Requests:

800-421-9064

Nursing Facility:

800-453-2273

Mental Health Drugs:

800-453-2273

Denials and Appeals

Only a patient or family member can appeal a prior authorization denial
The member has 30 days from receipt of the denial letter to submit a written appeal to the address below:
- Kentucky Department for Medicaid Services
  Division of Administration and Financial Management
  Administrative Services Branch, 6W-C
  275 East Main Street
  Frankfort, KY 40621-0001
The prescribing physician can attend the appeal hearing and testify on the patient’s behalf

Pharmacy and Therapeutics Advisory Committee

Item	Last Modified
Information about the Pharmacy and Therapeutics Advisory Committee	External URL
P & T Class Schedule	04/12/2022
P & T Member List	09/02/2021

Forms

Item	Last Modified
P & T Speaker Request Form - PDF	01/11/2022
P & T Speaker Request Form - Word	01/11/2022

This Year’s Meetings

Meeting Date	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
May 19, 2022	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
March 17, 2022	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions

Previous Year’s Meetings

Meeting Date	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
November 18, 2021	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
September 30, 2021	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
May 20, 2021	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
March 18, 2021	Agenda	Options	Committee Recommendations	Commissioner’s Final Decisions

Directions

Title	Last Modified
Capitol Annex Directions	06/09/2014
Frankfort, KY Map	04/26/2010

Pharmacy and Therapeutics Advisory Committee Archives

Meeting Date	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
November 19, 2020 (Special Called Meeting)	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
September 17, 2020 (Special Called Meeting)	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
May 21, 2020 (Special Called Meeting)	Agenda	Options	Committee Recommendations	Commissioner's Final Decisions
March 19, 2020	Agenda	Options	Cancelled	Cancelled

November 21, 2019	Last Modified
Agenda	10/29/2019
Options	10/29/2019
Commissioner’s Final Decisions	12/11/2019
Committee Recommendations	12/11/2019

September 19, 2019	Last Modified
Agenda	08/29/2019
Options	08/29/2019
Commissioner’s Final Decisions	09/27/2019
Committee Recommendations	09/27/2019

May 16, 2019	Last Modified
Agenda	04/30/2019
Options	04/30/2019
Commissioner’s Final Decisions	06/10/2019
Committee Recommendations	06/10/2019

March 21, 2019	Last Modified
Agenda	03/05/2019
Options	03/05/2019
Commissioner’s Final Decisions	04/10/2019
Committee Recommendations	04/10/2019

November 15, 2018	Last Modified
Agenda	10/29/2018
Options	10/29/2018
Commissioner’s Final Decisions	01/04/2019
Committee Recommendations	01/04/2019

September 20, 2018	Last Modified
Agenda	09/04/2018
Options	09/04/2018
Commissioner’s Final Decisions	11/01/2018
Committee Recommendations	11/01/2018

May 17, 2018	Last Modified
Agenda	05/03/2018
Options	05/07/2018
Commissioner’s Final Decisions	06/15/2018
Committee Recommendations	06/01/2018

March 15, 2018	Last Modified
Agenda	02/26/2018
Options	02/26/2018
Commissioner’s Final Decisions	04/05/2018
Committee Recommendations	04/05/2018

November 16, 2017	Last Modified
Agenda	11/02/2017
Options	11/02/2017
Commissioner’s Final Decisions	12/27/2017
Committee Recommendations	12/27/2017

September 21, 2017	Last Modified
Agenda	09/12/2017
Options	09/12/2017
Commissioner’s Final Decisions	12/01/2017
Committee Recommendations	11/15/2017

May 18, 2017	Last Modified
Agenda	04/28/2017
Options	04/28/2017
Commissioner’s Final Decisions	11/15/2017
Committee Recommendations	11/15/2017

March 16, 2017	Last Modified
Agenda	03/16/2017
Options	03/16/2017
Commissioner’s Final Decisions	11/15/2017
Committee Recommendations	11/15/2017

November 17, 2016	Last Modified
Agenda	11/04/2016
Options	11/04/2016
Commissioner’s Final Decisions	11/15/2017
Committee Recommendations	11/15/2017

September 15, 2016	Last Modified
Agenda	08/23/2016
Options	08/23/2016
Commissioner’s Final Decisions	11/15/2017
Committee Recommendations	11/15/2017

May 19, 2016	Last Modified
Agenda	05/10/2016
Options	05/10/2016
Commissioner’s Final Decisions	11/15/2017
Committee Recommendations	11/15/2017

March 17, 2016	Last Modified
Agenda	03/04/2016
Options	03/04/2016
Committee Recommendations	01/11/2017
Commissioner’s Final Decisions	01/11/2017

January 21, 2016	Last Modified
Agenda	01/21/2016
Options	01/21/2016
Committee Recommendations	01/11/2017
Commissioner’s Final Decisions	01/11/2017

November 19, 2015	Last Modified
Agenda	05/10/2016
Options	05/10/2016
Commissioner’s Final Decisions from November 19, 2015	05/10/2016
Cancelled due to lack of quorum	N/A

September 17, 2015	Last Modified
Agenda	08/28/2015
Options	08/28/2015
Commissioner’s Final Decisions from September 17, 2015	01/06/2016
Cancelled due to lack of quorum	N/A

July 16, 2015	Last Modified
Agenda	06/30/2015
Options	06/30/2015
Commissioner’s Final Decisions from July 16, 2015	09/16/2015

May 21, 2015	Last Modified
Agenda	05/05/2015
Options	05/05/2015
Commissioner’s Final Decisions from May 21, 2015	07/28/2015
Cancelled due to lack of quorum	N/A

March 19, 2015	Last Modified
Commissioner’s Final Decisions from March 19, 2015	04/21/2015
Cancelled due to lack of quorum	N/A

January 15, 2015	Last Modified
Commissioner’s Final Decisions from January 15, 2015	02/25/2015
Cancelled due to lack of quorum	N/A

November 20, 2014	Last Modified
Agenda	11/06/2014
Options	11/06/2014
Commissioner’s Final Decisions from November 20, 2014	12/16/2014
Cancelled due to lack of quorum	N/A

September 18, 2014	Last Modified
Agenda	09/18/2014
Options	09/18/2014
Commissioner’s Final Decisions from September 18, 2014	10/20/2014
Cancelled due to lack of quorum	N/A

July 17, 2014	Last Modified
Agenda	07/17/2014
Options	07/17/2014
Cancelled due to lack of quorum	N/A

May 15, 2014	Last Modified
Cancelled due to lack of quorum	N/A

March 20, 2014	Last Modified
Agenda	02/28/2014
Options	02/28/2014
Committee Recommendations	03/26/2014
Commissioner’s Final Decisions from March 20, 2014	03/26/2014

January 16, 2014	Last Modified
Cancelled due to lack of quorum	N/A

November 21, 2013	Last Modified
Agenda	10/31/2013
Options	10/31/2013
Committee Recommendations	11/27/2013
Commissioners Final Decisions from November 21, 2013	02/03/2014

September 19, 2013	Last Modified
Agenda	08/30/2013
Options	08/30/2013
Committee Recommendations	09/23/2013
Commissioners Final Decisions from September 19, 2013	12/10/2013

July 18, 2013	Last Modified
Cancelled due to lack of quorum	N/A

May 16, 2013	Last Modified
Cancelled due to lack of quorum	N/A

March 21, 2013	Last Modified
Agenda	03/05/2013
Options	03/11/2013
Committee Recommendations	03/27/2013
Commissioners Final Decisions from March 21, 2013	07/05/2013

January 17, 2013	Last Modified
Agenda	12/27/2012
Options	12/27/2012
Cancelled due to lack of quorum	N/A

November 15, 2012	Last Modified
Agenda	10/30/2012
Options	10/30/2012
Committee Recommendations	11/21/2012
Commisioner's Final Decisions from November 15, 2012	01/08/2013

September 20, 2012	Last Modified
Cancelled due to lack of quorum	N/A

July 19, 2012	Last Modified
Agenda	06/27/2012
Options	06/27/2012
Committee Recommendations	07/24/2012
Commisioner's Final Decisions from July 19, 2012	08/20/2012

May 17, 2012	Last Modified
Cancelled due to lack of quorum	N/A

March 15, 2012	Last Modified
Agenda	02/27/2012
Options	02/27/2012
Committee Recommendations	03/20/2012
Secretary's Final Decisions from March 15, 2012	04/24/2012

January 19, 2012	Last Modified
Agenda	01/05/2012
Options	01/05/2012
Cancelled due to lack of quorum	N/A

November 17, 2011	Last Modified
Cancelled due to lack of quorum	N/A
Agenda	11/02/2011
Options	11/02/2011

September 15, 2011	Last Modified
Cancelled due to lack of quorum	N/A
Agenda	08/30/2011
Options	08/30/2011

July 21, 2011	Last Modified
Agenda	07/06/2011
Options	07/06/2011
Committee Recommendations	07/25/2011
Secretary's Final Decisions from July 21, 2011	08/26/2011

May 19, 2011	Last Modified
Agenda	05/02/2011
Options	05/02/2011
Committee Recommendations	05/24/2011
Secretary's Final Decisions from May 19, 2011	06/27/2011

March 17, 2011	Last Modified
Agenda	02/28/2011
Options	02/28/2011
Committee Recommendations	03/23/2011
Secretary's Final Decisions from March 17, 2011	04/26/2011

January 20, 2011	Last Modified
Cancelled due to lack of quorum	N/A
Agenda	01/05/2011
Options	01/05/2011

November 18, 2010	Last Modified
Agenda	11/01/2010
Options	11/01/2010
Committee Recommendations	11/24/2010
Secretary's Final Decisions from November 18, 2010	01/05/2011

September 16, 2010	Last Modified
Agenda	09/01/2010
Options	09/01/2010
Committee Recommendations	09/22/2010
Secretary's Final Decisions from September 16, 2010	10/28/2010
Speaker Request Form	09/01/2010

July 15, 2010	Last Modified
Cancelled due to lack of quorum	N/A
Agenda	06/28/2010
Options	06/28/2010

May 20, 2010	Last Modified
Agenda	05/05/2010
Options	05/05/2010
Committee Recommendations	05/27/2010
Secretary's Final Decisions from May 20, 2010	06/28/2010
Speaker Request Form	05/05/2010

March 18, 2010	Last Modified
Agenda	03/03/2010
Options	03/03/2010
Committee Recommendations	03/24/2010
Secretary's Final Decisions from March 18, 2010	05/19/2010
Speaker Request Form	03/03/2010

Title	Last Modified
June 2022 - Volume 13, Number 2	06/28/2022
March 2022 - Volume 13, Number 1	03/31/2022
December 2021 - Volume 12, Number 4	12/31/2021
September 2021 - Volume 12, Number 3	09/28/2021
June 2021 - Volume 12, Number 2	06/23/2021
March 2021 - Volume 12, Number 1	03/15/2021
December 2020 - Volume 11, Number 4	12/31/2020
September 2020 - Volume 11, Number 3	09/22/2020
June 2020 - Volume 11, Number 2	06/29/2020
March 2020 - Volume 11, Number 1	03/16/2020
March 2019 - Volume 10, Number 1	03/11/2019
September 2018 - Volume 9, Number 3	09/25/2018
May 2018 - Supplemental Information: Hepatitis A	06/15/2018
May 2018 - Volume 9, Number 2	05/29/2018
February 2018 - Volume 9, Number 1	02/09/2018

Electronic Remittance Advice (ERA) Information

Magellan Medicaid Administration has provided a website to satisfy the CAQH Committee Operating Rules for Information Exchange (CORE) mandate requiring online capability for Electronic Remittance Advice (ERA) enrollment. The form can be completed and electronically submitted via the web portal at https://eftera.magellanrx.com.

Additionally, paper Electronic Remittance Advice (ERA) enrollment forms have been revised in order to satisfy the CAQH Committee Operating Rules.

Electronic Remittance Advice (ERA)

To submit a request to receive an Electronic Remittance Advice (ERA) via the website go to https://eftera.magellanrx.com.
Electronic Remittance Advice (ERA) Help Document with Instructions

If you prefer to submit a paper form to receive an Electronic Remittance Advice (ERA) you can access the form and instructions here — ERA Paper Form (with Instructions & FAQ).

Note: If you would like to receive a paper Remittance Advice please contact Pharmacy Networks Services at 800-441-6001.

Medicaid Client Portal

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