Approved EPSDT Pharmacy Request

Early Periodic Screening Detection and Treatment (EPSDT) requests can be made by prescribers for children in the North Carolina Medicaid program for non-covered medications or services. In the past, a pharmacy who accepted such a request had to fill out and send in a paper claim to be paid. NCTracks will have the ability to enter EPSDT requests as a prior authorization, so that such the claim can be billed at Point-of-Sale. However, the functionality is not yet available in NCTracks. In the interim, pharmacy providers who have an EPSDT request and do not currently send claims directly to DMA are asked to continue to provide service to these children. Once the functionality is available, providers will be able to rebill these claims to NCTracks and be reimbursed.