Further Clarification of the New Edits and Automatic Status Updates for 340B Pharmacies

On Sept. 12, NCTracks announced that effective Oct. 23, 2022, NCTracks will receive the Health Resources and Services Administration (HRSA) Provider File as the source of provider 340B status instead of providers needing to self-attest during enrollment. 

This change in NCTracks does not impact providers’ ability to exclude utilization of 340B stock for Medicaid prescriptions. A provider that “carves out” (excludes) Medicaid from their 340B program may continue to dispense non-340B supply to Medicaid members. If a 340B provider submits a non-340B purchased drug for a Medicaid beneficiary, they may need to enter Submission Clarification Code 99 if they receive National Council for Prescription Drug Programs (NCPDP) response "340B Provider Billed Non-340B claim."

Outpatient pharmacy 340B claims require the actual acquisition cost be submitted in the Usual and Customary field. If the acquisition cost submitted is greater than the estimated 340B rate for the NDC submitted, the pharmacy claim will receive edit 02214 (U&C EXCEEDS ESTIMATED 340B RATE). If the submitted cost in the U&C field is incorrect, the pharmacy should make the correction and resubmit. If the acquisition cost is correct, the pharmacy can override the edit with DAW = 6. Any questions or concerns with estimated 340B rates can be directed to the Myers & Stauffer Help Desk at 800-591-1183.