- A pharmacy must meet eligibility rules to qualify as a Medicaid provider.pr??paratrices en pharmacie image by c??dric chabal from Fotolia.com
Ohio's Medicaid laws and rules concerning pharmacy billing establish eligible providers and services available to Medicaid beneficiaries. Providers that want to conduct services that permit pharmacy billing to Medicaid must sign an agreement with the Department of Job and Family Services, the entity in Ohio that manages the Medicaid service, agreeing to follow the program's rules. - Providers that are eligible for reimbursement under Medicaid's pharmacy billing rules are pharmacy providers, hospitals and other providers. To qualify as a pharmacy provider, a business or entity must possess a current Drug Enforcement Agency number, employ a licensed and registered pharmacist whose responsibilities include maintaining actual and full charge of a pharmacy, and sign the Ohio Medicaid provider agreement. A hospital is eligible if it meets all of the qualifications for a pharmacy. Ohio's Medicaid service will categorize the hospital as a prescribed drug service with permission to prescribe take-home drugs that a patient may self-administer. Other providers are those that possess a credible Medicaid provider service agreement and may dispense pharmaceuticals, but don't meet the qualifications of a pharmacy. Medicaid categorizes other providers as a prescribed drug service.
- Ohio's Medicaid provider service agreement is a contract that permits health care providers that meet Medicaid guidelines to participate in the program and provide treatment to Medicaid beneficiaries. The guidelines in the agreement cover treatment options and billing standards, and include the following rules. The provider must provide, without regard to factors such as race, sex or religion, medically necessary and required treatment for the standard charge for that treatment. The provider must determine and collect the patient's third-party resources available for the charge amount before billing Ohio's Medicaid service. By signing the agreement, the provider agrees to accept Medicaid's allowable amount for the reimbursement of medical treatment. Providers must document all treatment they provide to Medicaid beneficiaries and all financial transactions for those treatments.
- Medical providers who qualify for pharmacy billing under Ohio's Medicaid rules are subject to quantity limits for the amount of each drug prescribed, and billed for, during a certain time period. The time period for most pharmaceuticals is one day, but certain drugs, such as cough syrup containing codeine, have time periods that last one month.
