Discarded physician-administered medications
According to a recent change made to the
AHCCCS Medical Policy Manual, Chapter 310 - Covered Services, 310-V Prescription Medications/Pharmacy Services
, discarded federally and state reimbursable physician-administered medications shall not be billed to AHCCCS or its Contractors. A.A.C. R9-22-209(C) provides that pharmaceutical services are covered only if they are prescribed. The unused portion of a physician administered drug is not covered because it is not medically necessary or prescribed.
A.R.S. §36-2918(A)(1) prohibits a person from making a claim for an item or service that the person knows or has reason to know was not provided as claimed.
A.R.S. §36-2918(A)(3)(b) prohibits a person from submitting a claim for items and services that substantially exceed the needs of the patient.
Both Mercy Care Plan and Mercy Maricopa follow all AHCCCS policies and we want to make you aware of this recent policy change.
As always, don't hesitate to contact your
Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our
Mercy Care Plan
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