Instructions for Form F-00030 State and Specialty Maximum Allowed Cost Drug Pricing Review Request - Wisconsin

Form F-00030 State and Specialty Maximum Allowed Cost Drug Pricing Review Request - Wisconsin

This document contains official instructions for Form F-00030 , State and Specialty Maximum Allowed Cost Drug Pricing Review Request - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-00030 is available for download through this link.

FAQ

Q: What is Form F-00030?A: Form F-00030 is a document used for State and Specialty Maximum Allowed Cost Drug Pricing Review Request in Wisconsin.

Q: What is the purpose of Form F-00030?A: The purpose of Form F-00030 is to request a review of the maximum allowed cost pricing for drugs in Wisconsin.

Q: Who can use Form F-00030?A: Form F-00030 can be used by healthcare providers, facilities, and pharmacies in Wisconsin.

Q: What information is required on Form F-00030?A: Form F-00030 requires information such as the drug name, strength, NDC, quantity, and the reason for the pricing review.

Q: Is there a deadline for submitting Form F-00030?A: Yes, Form F-00030 must be submitted within 30 days of the date on the payment remittance advice.

Q: How long does it take to receive a response to a Form F-00030 request?A: The Wisconsin Department of Health Services aims to provide a response to Form F-00030 requests within 30 days of receipt.

Q: Can I appeal the decision made on Form F-00030?A: Yes, if you disagree with the decision made on Form F-00030, you can request an appeal within 30 days of receiving the response.

Q: Are there any fees associated with submitting Form F-00030?A: No, there are no fees associated with submitting Form F-00030.