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Manuals
Item Last Modified
Pharmacy Provider Billing Manual 02/07/2020
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 10/07/2021) 10/07/2021
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 #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
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 #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 09/02/2021
P & T Member List 09/02/2021
Forms
Item Last Modified
P & T Speaker Request Form - PDF 09/02/2021
P & T Speaker Request Form - Word 09/02/2021
This Year’s Meetings
Meeting Date 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
Previous Year’s Meetings
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
Directions
Title Last Modified
Capitol Annex Directions 06/09/2014
Frankfort, KY Map 04/26/2010
Pharmacy and Therapeutics Advisory Committee Archives
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
Commissioner’s 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
Commissioner’s 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
Commissioner’s 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

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.