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

Instructions for 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.

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Instruction Details:

  • This 2-page document is available for download in PDF;
  • Actual and applicable for the current year;
  • Complete, printable, and free.

Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Wisconsin Department of Health Services.

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