RA Messages for
November 30, 1999
PHARMACY
PROVIDERS, PLEASE NOTE!!!
IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE
CONTACT
THE PBM HELP DESK AT 1-800-648-0790.
PLEASE MAKE THE FOLLOWING
CHANGES TO THE 8/15/98 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| CODEINE PHOS/APAP |
ELIXIR |
|
OFF MAC |
11/30/99 |
| CYPROHEPTADINE |
SYRUP |
2MG/5ML |
OFF MAC |
11/30/99 |
| DELAVIRDINE MESYLATE |
TABLET |
200MG |
|
10/26/99 |
| ENTACAPONE |
TABLET |
200MG |
|
10/22/99 |
| GENTAMICIN SULFATE |
DROPS |
0.3% |
$1.40000 |
11/30/99 |
| LITHIUM CARBONATE |
TABLET |
300MG |
$0.19210 |
11/30/99 |
| NAPH,MB-DB/K PH,MBDB |
POWDER |
|
|
09/13/99 |
| OSELTAMIVIR PHOSPHATE |
CAPSULE |
75MG |
|
10/28/99 |
| PRENAT VIT/FE,CARBO/DOSS/CA/FA |
TABLET |
90-1MG |
|
10/12/99 |
| PROPRANOLOL HCL |
CAP SA |
60MG |
OFF MAC |
11/16/99 |
| PROPRANOLOL HCL |
CAP
SA |
80MG |
OFF MAC |
11/16/99 |
| PROPRANOLOL HCL |
CAP SA |
120MG |
OFF
MAC |
11/16/99 |
| PROPRANOLOL HCL |
CAP SA |
160MG |
OFF MAC |
11/16/99 |
| ZAFIRLUKAST |
TABLET |
10MG |
|
10/18/99 |
PLEASE
FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
DHH AND UNISYS WANT TO THANK YOU FOR PROVIDING A CONSISTENT
LEVEL OF EXCELLENCE IN YOUR SERVICE OF MEDICAID RECIPIENTS. PLEASE KNOW
THAT THE CLAIMS PROCESSING SYSTEM (LMMIS) IS READY FOR BUSINESS AS USUAL IN THE
YEAR 2000. WE RECOGNIZE THE BENEFIT OF BEING READY FOR POTENTIAL
EMERGENCIES, CAUSED BY Y2K TECHNOLOGY FAILURES, AND THE NECESSITY OF ENSURING
RECIPIENTS CONTINUE TO RECEIVE SERVICES. WE ENCOURAGE YOU TO GET AN EARLY
START ON PLANNING. YOU MAY WISH TO CONTACT YOUR LOCAL AMERICAN RED CROSS
OFFICE TO OBTAIN A COPY OF THEIR BOOKLET ON Y2K PREPAREDNESS OR VISIT THEIR
INTERNET SITE. PLEASE COMMUNICATE WITH YOUR BUSINESS PARTNERS AND
CLIENTELE REGARDING YOUR Y2K READINESS. WE WOULD APPRECIATE YOUR
ASSISTANCE IN BEING A REASSURING INFORMATION VEHICLE TO HELP EASE YOUR PATIENT'S
FEAR REGARDING THE CHANGEOVER TO THE NEW MILLENNIUM.
ATTENTION DENTAL PROVIDERS
UNTIL FURTHER NOTICE, PLEASE DO NOT SUBMIT THE NEW 1999 AMERICAN
DENTAL ASSOCIATION (ADA) DENTAL CLAIM FORM FOR PAYMENT OF MEDICAID DENTAL CLAIMS
OR FOR MEDICAID DENTAL PRIOR AUTHORIZATION DETERMINATIONS. THESE SYSTEMS
ARE CURRENTLY NOT CAPABLE OF PROCESSING THESE FORMS AND THEY WILL BE RETURNED TO
YOU WITHOUT BEING PROCESSED. WHEN THESE SYSTEMS ARE ADJUSTED TO ACCEPT THE
1999 VERSION OF THE ADA DENTAL CLAIM FORM YOU WILL BE NOTIFIED. AT A
FUTURE DATE, WE EXPECT TO MAKE THE 1999 VERSION OF THE ADA DENTAL CLAIM FORM
MANDATORY FOR USE AND, AT THAT TIME, WILL BE THE ONLY DENTAL CLAIM FORM ACCEPTED
FOR MEDICAID DENTAL CLAIMS PROCESSING OR DENTAL PRIOR AUTHORIZATION
DETERMINATIONS. YOU WILL BE NOTIFIED WHEN THIS CLAIM FORM BECOMES
MANDATORY AND WILL BE ALLOWED A TRANSITION PERIOD IN ORDER TO ADHERE TO THIS NEW
REQUIREMENT. SHOULD YOU HAVE ANY QUESTIONS YOU MAY CONTACT UNISYS PROVIDER
RELATIONS BY CALLING 1-800-473-2783 (OR 225-924-5040).
NEW CODES
THE FOLLOWING PROCEDURE CODES HAVE BEEN ESTABLISHED
EFFECTIVE 01/01/2000 WITH A PAC OF 880 FOR MANUAL PRICING:
Z4150 - ENTERAL FORMULA CATEGORY I; SEMI-SYNTHETIC INTACT
PROTEIN/PROTEIN ISOLATES; ORAL-FED, 100 CALORIES=1 UNIT ($.61/UNIT)
Z4151 - ENTERAL FORMULA CATEGORY I; NATURAL INTACT
PROTEIN/PROTEIN ISOLATES; ORAL-FED, 100 CALORIES=1 UNIT ($1.43/UNIT)
Z4152 - ENTERAL FORMULA CATEGORY II; INTACT
PROTEIN/PROTEIN ISOLATES; ORAL-FED, 100 CALORIES=1 UNIT ($.51/UNIT)
Z4153 - ENTERAL FORMULA CATEGORY III; HYDROLIZED PROTEIN/AMINO
ACID; ORAL-FED, 100 CALORIES=1 UNIT ($1.74/UNIT)
Z4154 - ENTERAL FORMULA CATEGORY IV; DEFINED FORMULA FOR SPECIAL METABOLIC
NEED; ORAL-FED, 100 CALORIES=1 UNIT ($1.12/UNIT)
Z4155 - ENTERAL FORMULA CATEGORY V; MODULAR COMPONENTS (PROTEIN,
CARBOHYDRATES, FAT); ORAL-FED, 100 CALORIES=1 UNIT ($.87/UNIT)
Z4156 - ENTERAL FORMULA CATEGORY V; STANDARDIZED NUTRIENTS; ORAL-FED, 100
CALORIES=1 UNIT ($1.24/UNIT)
THESE CODES TRACK THE DESCRIPTIONS AND PRICING OF CODES B4150 THROUGH B4156
FOR ENTERAL FORMULAS WITH THE EXCEPTION THAT THEY ARE TO BE USED FOR ORAL-FED
FORMULAS ONLY. EFFECTIVE IMMEDIATELY, PLEASE BEGIN USING THESE NEW
"Z" CODES FOR PRIOR AUTHORIZATION REQUESTS FOR ORAL-FED FORMULAS WITH
DATES OF SERVICE OF 01/01/2000 AND AFTER. THE PRIOR AUTHORIZATION UNIT
WILL ALSO BEGIN TO, EFFECTIVE IMMEDIATELY, SUBSTITUTE THE APPROPRIATE
"Z" CODE FOR ORAL-FED ENTERAL FORMULA REQUESTS SUBMITTED TO
THEM. BY USING THESE NEW "Z" CODES FOR ORAL-FED FORMULAS, IT
WILL NO LONGER BE NECESSARY TO SUBMIT CLAIMS FOR THEM TO BHSF FOR AN OVERRIDE OF
THE MEDICARE EDIT.