Change Healthcare continues to monitor the rapidly evolving situation surrounding new regulations pertaining to medical claims billing and COVID-19, and will provide updates as circumstances change. Any questions regarding this notification, please contact Pharmacy Support at 866-379-6389.
Return to this page for the latest notices and updates related to MedRx and COVID-19 claims.
Current Medicare rules for immunosuppressive drugs used after an organ transplant, oral anticancer drugs, and intravenous immune globulin (IVIG) utilization requirements generally limit dispensing of drug amounts to a 30-day supply. Due to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) now allows Medicare beneficiaries to obtain amounts of Part B drugs in excess of the current monthly (30-day) limitation. This change is effective for claims with dates of service on or after March 1, 20201.
Change Healthcare has adjusted the MedRx day-supply edits to accommodate the adjusted supply limitations for those drugs indicated in the above publication.
In order to allow claims for these items to process more than a 30-day supply for the Medicare Part B drug categories referenced by the DME MACs, the following needs to be provided:
1. (Joint DME MAC Article) Billing of Part B Drugs to DME MACs During COVID-19 Pandemic – Dispensing Amounts