Non-Risk Payments for Second Generation Direct Acting Antivirals for Hepatitis C Sample Clauses

Non-Risk Payments for Second Generation Direct Acting Antivirals for Hepatitis C. The capitation rates do not include the costs of second generation direct acting antivirals (DAAs) for the treatment of hepatitis C as described in Attachment B-1, Section 8.1.21.17. For providing these drugs to Members, HHSC will make non-risk payments to the MCO based on pharmacy encounter data received by HHSC’s Administrative Services Contractor during an encounter reporting period. The first non-risk payment will cover pharmacy encounter data received from the date the drugs are added to the Medicaid and CHIP formularies through the end of that State Fiscal Quarter. Thereafter, non-risk payments will cover quarterly encounter reporting periods. HHSC will make non-risk payments within a reasonable amount of time after the encounter reporting period, generally no later than 95 calendar days after HHSC’s Administrative Services Contractor has processed the encounter data. Non-risk payments will be limited to the actual amounts paid to pharmacy providers for these drugs as represented in “Net Amount Due” field (Field 281) on the National Council for Prescription Drug Programs (NCPDP) encounter transaction. To be eligible for reimbursement, pharmacy encounters must contain a Financial Arrangement Code “14” in the “Line of Business” field (Field 270) on the NCPDP encounter transaction.
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Related to Non-Risk Payments for Second Generation Direct Acting Antivirals for Hepatitis C

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