Express Scripts: Amerigroup - Claims Processing Changes

Effective April 17th 2017 Therapy Duplication DUR soft edits

Author: Kailee Burnett/Wednesday, April 26, 2017/Categories: APCI Choice

Amerigroup currently uses passive alerts for DUR therapy duplication edits. Effective April 17, soft block edits will be implemented and claims will reject with NCPDP reject 88 "DUR Reject Error". A secondary message will provide the appropriate conflicting drug.

Please review the therapy duplication alerts to determine if the therapy is appropriate. If needed, pharmacists should contact the physician to ensure the appropriate therapy. If the therapy is appropriate, a point-of-sale override can be entered to allow claims to process. A list of codes for therapy duplication edits is included below. Pharmacists need to enter one code from each category in order to override the claim.

*Please see attached PDF for more information.

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