N.M. Admin. Code § 8.324.4.17

Current through Register Vol. 35, No. 17, September 10, 2024

Section 8.324.4.17 - POINT OF SALE

The point-of-sale system provides relevant drug utilization information that the pharmacist must consider before dispensing a drug. If utilization information indicates that a MAP eligible recipient has an adequate supply of the drug item or that the quantity being dispensed is excessive, the claim will initially be denied. The pharmacist is responsible for resolving the issue and obtaining an authorization to dispense the drug, if necessary.

A.General requirements: All MAD in-state and border area pharmacy providers are required to submit claims through the point-of-sale system.

B.Exceptions to general requirements: The following are exceptions to this general requirement:

(1) the provider is out-of-state and is not a border area provider;

(2) the provider is a family planning clinic dispensing prescriptions;

(3) the provider submitted on average less than 50 claims per month to MAD for the preceding six-month period;

(4) the claim requires an attachment or explanation; or

(5) a required data element on the claim cannot be entered in the current standard point-of-sale format.

N.M. Admin. Code § 8.324.4.17

8.324.4.17 NMAC - Rp, 8.324.4.17 NMAC, 1-1-14