Hurricane Florence and Early Refill (ER) Overrides

Governor Cooper has declared a state of emergency for North Carolina in anticipation of potential severe weather caused by the approach of Hurricane Florence. See the NC declaration of a state of emergency here.

The potential for severe weather conditions may present situations where NC Medicaid and Health Choice beneficiaries in impacted areas may require an early refill of their medications. In these situations, NC Medicaid enrolled pharmacy providers should resubmit these claims with “09” (Emergency Preparedness) in the PA Type Code field and a valid value for an E.R. override in the Reason for Service, Professional Service and Result of Service fields to override a denial for an early refill. Do not place any values in the Submission Clarification Code field.

Co-pay requirements are also applicable to these pharmacy claims. The use of this override is allowed while the governor's state of emergency order remains in place.