According to North Dakota Century Code (N.D.C.C) Section 50-06-40, passed in 2015 by the 64th Legislative Assembly, this medication therapy management program has been established to reduce unnecessary costs including escalation of therapy, ER visits, hospital admissions, and exacerbations due to poor disease control and non-compliance.
Step 1: Enrolling as an MTM Provider
Fill out the MTM Provider Enrollment Application (SFN 1105) and fax to 701-328-1544 with "Attn: Pharmacy" on cover sheet. Required Attachments
Active North Dakota State pharmacy license
CPE Monitor printout verifying the ACPE continuing education requirements have been met within the last 4 years (2 hours of CE specific to the MTM Delivery/Documentation and Medication Adherence; 4 hours total of CE specific to chronic disease states)
Step 2: Enroll in North Dakota Medicaid
A Medicaid MTM pharmacist’s place of business is eligible for reimbursement. Payments for MTM services are made to a place of business enrolled as a ND Medicaid provider, not directly to MTM pharmacists.
Presumably, if your pharmacy is already serving North Dakota Medicaid patient through prescription services, this step has already been completed in order to be reimbursed for those services. Group Provider enrollment can be completed through the North Dakota MMIS Web Portal.
Step 3: Space Requirements for MTM Visit
The place of business where MTM services are provided must: 1) Have size and accommodations to comfortably seat at least three people comfortably and 2) Be enclosed sufficiently to prevent:
Patient consultation from being heard or seen by others
Distracting noise from other areas of the business interfering with consultation
Step 4: Understand MTM Reimbursement
Pharmacy providers can be reimbursed for delivering three levels of MTM service codes to North Dakota Medicaid members. These are categorized using CPT codes that describe the level of care provided and include the following:
99605 - A first encounter performed face-to-face with a patient in a time increment of 8 to 15 minutes ($70)
99606 - Follow-up encounter use with the same patient in a time increment of 8 to 15 minutes for a subsequent or follow-up encounter ($25)
99607 - Additional increments of 8 to 15 minutes used to add on to 99605 and 99606 encounters ($25)
Pharmacist billing through DocStation can earn up to $345 per member per rolling year in the North Dakota MTM program!
It is important to note that an initial visit (CPT 99605) can only be performed once per member per rolling year, while the follow-up visit (CPT 99606) can be performed up to five times per member per rolling year. The additional time modifier can be used once per date of service The number of visits a patient is eligible is tied to a set eligibility criteria. For more information refer to the North Dakota Provider Manual for Medication Therapy Management.
Note: DocStation "Getting Started" assistance does not replace the requirements of the North Dakota Department of Human Services. Please refer to the North Dakota Provider Manual for Medication Therapy Management for complete guidance.