Claims Submitted for Only Drugs Listed on the Approved

100.2.8 - Claims Submitted for Only Drugs Listed on the Approved CAP Vendor’s Drug List (Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17) The A/B MAC (B) shall edit to verify that the no-pay lines (lines with the CAP drug HCPCS code and the J1modifier) that the participating CAP physician has billed is for a drug included in the CAP and is from the particular CAP vendor they have chosen to receive drugs from. If the A/B MAC (B) determines that the physician has billed no-pay lines along with the codes for the payment of the administration for drug HCPCS code(s) that are not provided by the approved CAP vendor that the physician had selected, it shall return as unprocessable those no-pay lines along with the lines for the codes for the payment of the administration for these drugs. The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three Group Code: CO CARC: 96 RARC: N348 MSN: 7.8