Summary
BCBS ND has updated pharmacy billing guidance to prevent duplicate billing of maintenance supplies when starter kits are dispensed. Billing teams must not bill maintenance supplies on the same claim as starter kits that already include those supplies. Maintenance supplies should only be billed after 70% or more of the starter kit supply is utilized (typically Day 21 or later for 30-day supplies).
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What to do
Action · 7 steps
01Effective immediately (July 9, 2026): Billing team must implement controls to prevent simultaneous billing of starter kits and maintenance supplies for pharmacy benefit claims submitted to BCBS ND.
02Configure billing system to block claims that bill a maintenance supply on the same date or within the same submission as a starter kit dispense for the same patient/product.
03Update pharmacy billing procedures and staff training to document the 70% utilization threshold rule (Day 21+ for 30-day starter kits).
04Implement a tracking mechanism to flag when maintenance supplies are eligible for billing based on days elapsed since initial starter kit fill.
05For existing starter kit claims already submitted, audit for duplicate maintenance supply billing and file corrected claims if needed.
06Update encounter templates or billing notes to remind pharmacy staff of this requirement.
07Contact BCBS ND Provider Services at 800-368-2312 or 833-777-5779 (Medicaid Expansion) with questions.
If missed: Failure to comply will result in claim denials and recoupment of inappropriately billed maintenance supplies.
Original notice
Pharmacy Benefit Billing Tips
bcbsnd.com · Always check the source before changing claims.