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Family PACT Claims Issue Resolved for Self-Administered Contraceptives

April 23, 2019

A NewsFlash article entitled “Family PACT Claims for Self-Administered Contraceptives Erroneously Denied” that published on January 28, 2019, notified providers that the Department of Health Care Services (DHCS) identified a claims processing issue causing Family Planning, Access, Care and Treatment (Family PACT) Program pharmacy claims for self-administered hormonal contraceptives to erroneously deny. Claims were denied with National Council for Prescription Drug Programs (NCPDP) reject code M4: Prescription/service reference number/time limit exceeded when a third fill of contraceptive was submitted. Pharmacy providers were advised to submit a Treatment Authorization Request (TAR) for the third supply and any subsequent fills of the same product of contraceptive vaginal rings, contraceptive patches or oral contraceptives requested within a year, until the issue was resolved.

The claims processing issue has been resolved, therefore, the interim process noted above is no longer necessary.

For more information on pharmacy dispensing of self-administered hormonal contraceptives under the Family PACT Program, providers may refer to the Family PACT Policies, Procedures and Billing Instructions.