Multi-ingredient Compounds
The system accepts multi-ingredient compounds in the compound segment of the B1 transaction. Only one compound claim is allowed per transmission and cannot be included as part of a multiple claim transaction. All ingredients of each compound must be submitted, and the system will only reimburse for products on the program-specific formulary. Pharmacy providers may submit up to 25 ingredients online, and the order of the ingredients does not matter. Refer to the Claims Billing (B1) Transaction payer sheets for specific transaction, segment, and field requirements.
| Field Name | Field Number | Usage |
|---|---|---|
|
Compound Code |
406-D6 |
Enter "2" (Compound). |
|
Product/Service ID Qualifier |
436-E1 |
Enter “00” |
|
Product/Service ID |
407-D7 |
Enter "0" |
|
Compound Type |
996-G1 |
Required. |
|
Compound Dosage Form Description Code |
450-EF |
Required. |
|
Compound Dispensing Unit Form Indicator |
451-EG |
Required. |
|
Compound Ingredient Component Count |
447-EC |
Required. |
|
Compound Product ID Qualifier |
488-RE |
Required. |
|
Compound Product ID |
489-TE |
Required. |
|
Compound Ingredient Quantity |
448-ED |
Required. |
To receive payment for non-covered products pharmacy providers should use the following fields:
| Field Name | Field Number | Usage |
|---|---|---|
|
Submission Clarification Code Count |
354-NX |
Enter the number of repetitions (1-3) of "Submission Clarification Code" |
|
Submission Clarification |
420-DK |
Enter "8" (Process Claim for Approved Compound Ingredients) |
Over the counter (OTC) products in compound claims for clients residing in a nursing home will be considered for payment only if a payable legend drug is included as part of the claims.
Certain drugs are only payable when submitted as part of a multi-ingredient compound claim. Refer to the Formulary search to find drugs with this limitation, or refer to the Compound-only Products section.
Compound claims submitted with home health supply products will reject. Refer to the Home Health Supplies section to learn more.
Multi-ingredient compound claims with vitamin or mineral products will not be paid. Refer to the Vitamins and Minerals section to learn more.
Enter the gross amount due of the total compounded product in the "Gross Amount Due" (GAD) field (430-DU).