Pharmacy

Provider Representative: Ann Bennett Tel.(571) 895-6866
email Ann.Bennett2@gainwelltechnologies.com

Please Note: Consumers with questions regarding prescriptions please contact your case manager.

Program Information

Reference Guide

Pharmacy Provider Manual

News

Stand-Alone Vaccine Counseling
The Rhode Island Medicaid Fee-For-Service (FFS) Stand-Alone Vaccine Counseling project was implemented, effective April 22, 2025.

This project allows pharmacies to be reimbursed for vaccine counseling services using the Service Billing (S1) and Service Reversals (S2) Transactions on the NCPDP transaction standard for the services listed below. This implementation is necessary due to the requirements posed in the CMS SHO #22-002 and the Public Readiness and Emergency Preparedness (PREP) Act which require stand-alone counseling for COVID-19 and state approved vaccines under Medicaid Early Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit where the recipient is a Medicaid beneficiary under the age of 21.

The RI FFS payer sheet was updated to reflect new values that will be allowed for processing the following HCPSC codes:
• G0314, COVID 19, ages under 21, 16 to 30 minutes
• G0315, COVID 19, ages under 21, 5 to 15 minutes
• G0312, ages under 21 (Non-COVID), 5 to 15 minutes
• G0313, ages under 21 (Non-COVID), 16 to 30 minutes

The following fields have additional values that will be accepted by RI FFS Medicaid to allow for the processing of this service:
103-A3 Transaction Code
455-EM Prescription/Service Reference Number Qualifier
436-E1 Product/Service ID Qualifier
407-D7 Product/Service ID

Please see the updated Payer Sheet below for the new values.

Frequently Asked Questions (FAQ's)

Policy for the Treatment of Hepatitis C (Updated January 1, 2022)
Where can I find the list of J Codes that require an NDC?
Where can I find information about the RI AIDS Drug Assistance Program (ADAP)?
Billing Part B Medications
DUR Alert Override Codes
Lost or Stolen Prescription Form and Instructions
CMS List of Rebateable Drug Manufacturers
Can pharmacies bill for administering vaccines?
No. Billing for administering vaccines is submitted by a medical provider in the Fee-for-Service Medicaid Program. For more information on vaccines go to: October 2018 Provider Update
How to bill NDCs on the CMS-1500 Form
NCPDP D.0 Payer Sheet (Effective April 14, 2025)
DESI Drug List (January 2025)
Do Smoking Cessation Products need a prior authorization? No, effective January 2014 no prior authorization is needed.