Pharmacy Frequently Asked Questions (FAQs)

The mechanism for entering ASAP and A+KIDS safety documentation has transitioned. Starting in November 2014, documentation can be submitted to NCTracks via the NCTracks Provider Portal Website (www.nctracks.nc.gov), an online system where providers can submit prior approval requests. Requests can also be submitted via fax (1-855-710-1969) or phone (1-866-246-8505).

Please visit documentforsafety.org for information about the ASAP and A+KIDS programs. Starting in November 2014, documentation can be submitted to NCTracks via the NCTracks Provider Portal Website (www.nctracks.nc.gov), an online system where providers can submit prior approval requests. Requests can also be submitted via fax (1-855-710-1969) or phone (1-866-246-8505).

Prior Authorization is not a guarantee of payment and only approves the medical necessity and appropriateness of the drug being requested and authorized. The determination for claims payment is made when the drug claim is submitted for processing.

In general, a PA is good for one year. In cases where the treatment term is several weeks or months but less than a year, the prescriber can specify the amount of time for which the PA is applicable.

CSRA notifies the prescriber who requests the prior authorization. However, the pharmacist may call CSRA at any time to check on the PA status, and all PA approvals will be entered into the claims processing system within 24 hours of the request, so the pharmacist can attempt to resubmit the claim and it should adjudicate after that time.

No; the prescriber must initiate a PA request. If the recipient arrives at the pharmacy and receives a claim denial, the pharmacist should contact the prescriber and have them submit a PA request. Pharmacists can call the NCTracks Call Center to check on the status of the PA at any time, if they want to know whether they can resubmit the claim.

An LTC Pharmacy can initiate the PA for all drugs except Brand Name Schedule II (CII) Narcotics and Sedative Hypnotics.

The advisory committee meets monthly. Any changes to the PA list will be communicated via mail and the website.

Yes, as long as they are the doctor's designee and they have the patient's file and medical information on hand.

All PA criteria are available on this website; please refer to the Prior Approval Drugs and Criteria page.

Pharmacists can dispense a 72-hour emergency supply (for instance, on a Friday evening after the doctor's office is closed). The pharmacist would then need to contact the prescriber on Monday morning and have them contact CSRA for the PA. Once the PA has been approved the remaining script could then be filled and the pharmacist would receive cost reimbursement and the dispensing fee. There will not be a dispensing fee for 72-hour supplies; it is thus in the pharmacist's best interest to wait until a PA decision is made and only submit the paper claim for cost reimbursement if the PA is denied.

Yes; the doctor can contact CSRA as soon as the prescription is written to request a PA and, if enough time has passed for the system to be updated with the PA, the script will then adjudicate when the recipient goes to the pharmacy.

The fastest way to receive a prior approval is to submit the PA request via the secure NCTracks Provider Portal at www.nctracks.nc.gov. (Access to the portal requires an NCID.)

Most PA requests will be completed during the initial contact, and usually within 24 hours. To expedite the process, it is recommended that the PA request be as complete as possible to eliminate the need of CSRA calling the prescriber for omitted necessary information. See PA forms to determine what is needed for the drug being prescribed.

No.

Yes, the Pharmacy PA call center is open normal business hours 365 days a year, including all holidays.

The claim will deny—usually after 1 year, unless the prescriber has specified otherwise.

No. The health care provider should keep the patient informed of the status of any PA requests.

The system has been updated to handle claims of any dollar value.

Via mail and website updates.

Prescription drugs billed through the Medicaid Pharmacy Program are subject to prior authorization. Drugs administered in a prescriber’s office are not billed through the Pharmacy program. IV drugs administered in the patient’s home and prescription drugs for patients in nursing homes are covered through the Medicaid Pharmacy Program and may therefore be subject to prior authorization.

Yes, the CSRA representative can view this information in the claims system.

A phone request is sufficient, as the call center representative will take down the necessary information while on the phone.

Yes; the PA's can be entered into the system through a web interface, or the pharmacist on call can go into the office to handle such requests.

The most expedient means is to complete the PA request on the portal.

PA follows the drug not Prescriber. Either can complete form if they have all the needed information.

Contact the prescriber next business day for a new RX.

The Physician signature is required on the Brand Name Schedule II (CII) Narcotics, Sedative Hypnotics, and Request for Patient Exemption from Prior Authorization Criteria forms.

No. Please refer to the Drug Request Forms page.

We have the capability to back date a prior authorization. Requests for this service will be considered case by case.

Yes.

Spiraling prescription drug prices are a severe drain of state funds. The drugs needing prior authorization are particularly high in cost or have a potential for overutilization or abuse. Prior authorization makes sure they are used responsibly and as they are intended.

In most cases authorization is given during the initial contact. Authorization will never take more than 24 hours.

Most requests for prior approval can be done over the phone, and the prescriber need not document the request or the approval. CSRA will enter authorizations into the POS online processing system so that pharmacists will be able to fill prescriptions.

If prior authorization has not been obtained for prior approval drugs, POS system will the reject the claim with NCPDP code 75 with the error message “PA Required” when you attempt to bill it.

Should a pharmacy need to dispense medication to a recipient in an emergency, the pharmacist calls CSRA for approval. If it is after hours and the call center is closed, the pharmacist can authorize a 72 hour supply.

Yes it does cover every prescription in that time period.  A PA can expire in one of two ways: either in time (the end date passes) or in units (if the provider requests 30 units for 30 days, but starts prescribing 60 units for 30 days, the PA will start to be used up at twice the rate, eventually the units will run out BEFORE the end date).

There is no limit to how many times they can resubmit a PA or when.  The providers can call us to change the quantity, we would be happy to assist if it is something we can change over the phone.  If not, we will request that they resubmit the PA with the updated quantity.