RA Messages for
December 14, 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 |
| CARBIDOPA
|
TAB |
25MG |
|
11/15/99 |
| CHLORAL
HYDRATE |
CAP |
500MG |
OFF
MAC |
12/06/99 |
| FLUORESCEIN
SODIUM |
STRIP |
0.12MG |
|
10/20/99 |
| OXYCODONE HCL/ACETAMINOPHEN |
TAB |
10-60;2.5-325;7.5-500 |
|
11/01/99 |
PLEASE
FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.
NEW CODES
ESTABLISHED
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.
ALL PROVIDER
- RE Y2K
AS PART OF OUR Y2K PREPARATION
TO ENSURE A SMOOTH TRANSITION THROUGH THE MILLENNIUM CHANGE, WE WILL CLOSE OUT
OUR WEEKLY AND YEARLY CLAIMS PROCESSING
FUNCTION ON TUESDAY, DECEMBER 28, 1999. IN
AN EFFORT TO MEET THIS DEADLINE, ELECTRONIC CLAIMS CUTOFFS WILL BE AS FOLLOWS:
KIDMED -5 P.M. MONDAY 12/27/1999; EMC TAPES AND DISKETTES - 5 P.M. MONDAY, 12/27/1999. AS IS CUSTOMARY, ALL REMITTANCE ADVICES, CHECKS,
AND EFT TRANSACTIONS FOR THE WEEK OF
12/27/1999 WILL BE PROCESSED AND HANDLED FOR
ALL PROVIDERS THE WEEK OF 01/03/2000. ONE
IMPORTANT NOTE: IN KEEPING WITH GOOD
BUSINESS PRACTICES, PLANNED DOWN TIME IS SCHEDULED FOR THE TRANSITION OF THE
MAINFRAME COMPUTER SYSTEM, WHICH IS LOCATED IN CALIFORNIA,
FROM 11 P.M. PACIFIC STANDARD TIME ON 12/31/1999, TO 2:30 A.M.
PACIFIC STANDARD TIME ON 01/01/2000. THIS
WILL AFFECT LOUISIANA PROVIDERS FROM
1:00 A.M. TO 4:30 A.M. CENTRAL STANDARD TIME ON 01/01/2000. DURING
THIS TIME PERIOD (1:00 A.M. TO 4:30 A.M.CENTRAL STANDARD
TIME ON 01/01/2000), POS AND MEVS WILL BE UNAVAILABLE. ALTHOUGH THE CLAIMS PROCESSING FUNCTION WILL CLOSE OUT
EARLY THE WEEK OF 12/27/1999, OUR OFFICES WILL CONTINUE TO BE OPEN FOR REGULAR
BUSINESS HOURS THROUGH THURSDAY,
12/30/1999. WE WILL BE CLOSED ON
FRIDAY, 12/31/1999, IN OBSERVANCE OF
THE NEW YEAR HOLIDAY. WE WILL
REOPEN FOR REGULAR BUSINESS HOURS
ON MONDAY, 01/03/2000.