RA Messages for February 17, 2004

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.

DRUG DOSAGE STRGTH MAC EFF DATE
OXYCODONE/ASPRIN TABLET 4.88 - 325 MG 0.75920 01/01/04
TESTOSTERONE CYPIONATE VIAL 100MG/ML OFF MAC 01/01/04

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

PLEASE MAKE THE FOLLOWING CHANGES TO THE 1/01/02 VERSION OR APPENDIX C:

LABELER COMPANY  BEGIN END
00209  MARSAM    04/01/04
11584 INTERNATIONAL ETHICAL LAB    04/01/04
12463 ABANA PHARMACEUTICALS, INC    04/01/04
17270 ARMSTRONG PHARMACEUTICALS  04/01/04   
54002 HYPERION MEDICAL, INC     04/01/04
61703 FAULDING PHARMACEUTICAL COMPANY    04/01/04
64054   AM2PAT, INC 01/01/04   
64679  WOCKHARDT AMERICAS  04/01/04   
65893 CODY LABORATORIES, INC   04/01/04
67000 VERUM PHARMACEUTICALS, INC    04/01/04
67402 SKIN MEDICA  04/01/04   
67555 PRONOVA CORPORATION 04/01/04   
67754  HARVEST PHARMACEUTICALS, INC  04/01/04   
68308 MIDLOTHIAN LABORATORIES  04/01/04   
68543 VICTORY PHARMA, INC   04/01/04   

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

NOTICE TO PHARMACIES AND PRESCRIBERS

UPDATED VERSIONS OF DRUG APPENDICES ARE NOW APPEARING ON THE WEB-SITE. THESE WILL BE REFRESHED MONTHLY. NOTICE THE DATES AT THE TOP OF EACH PAGE.                                                                 

                     HOME AND COMMUNITY-BASED WAIVER SERVICES

FOR INFORMATION ABOUT HOME AND COMMUNITY-BASED WAIVER SERVICES AS AN 
ALTERNATIVE LONG TERM CARE OPTION, PLEASE CALL 1-800-660-0488.

NOTICE TO DENTAL PROVIDERS

MEDICAID RECENTLY IDENTIFIED A PROBLEM THAT CAUSED THE ERRONEOUS DENIAL (EOB 917-LIFETIME LIMITS FOR THIS SERVICE HAVE BEEN EXCEEDED) OF SOME CLAIMS FOR PROCEDURE CODE D3310 (ANTERIOR ROOT CANAL) THAT WERE PROCESSED FROM MAY 1, 2003 THROUGH JANUARY 16, 2004 AND INCLUDED DATES OF SERVICE MAY 1, 2003 AND AFTER. THIS PROBLEM HAS BEEN CORRECTED AND ALL CLAIMS FOR PROCEDURE CODE D3310 THAT DENIED WITH ERROR CODE 917 WITHIN THE TIME PERIOD MENTIONED ABOVE WERE AUTOMATICALLY RECYCLED BY MEDICAID AND APPEARED ON THE REMITTANCE ADVICE DATED JANUARY 27, 2004. PLEASE KEEP IN MIND THAT NOT ALL CLAIMS THAT WERE RECYCLED WILL PAY. SOME MAY DENY FOR VALID REASONS SUCH AS DUPLICATE CLAIM, LACK OF PRIOR AUTHORIZATION, ETC. SHOULD YOU HAVE ANY QUESTIONS, YOU MAY CONTACT THE DENTAL MEDICAID UNIT BY CALLING 504-619-8589.

ATTENTION DME PROVIDERS

PROCEDURE CODE A4624 AND L8499 ARE BEING PLACED IN NON-PAY STATUS. WE HAVE IDENTIFIED VALID, HIPAA COMPLIANT PROCEDURE CODES THAT ARE MORE APPROPRIATE AND HAVE BEEN MADE PAYABLE EFFECTIVE WITH DATES OF SERVICE JANUARY 1, 2004 AND AFTER. PROVIDERS SHOULD BEGIN USING THE FOLLOWING CODES IMMEDIATELY, AS APPROPRIATE: A4609 - TRACHEAL SUCTION CATHETER/ LESS THAN 72 HOURS USE IN CLOSED SYSTEM ($10.01/CATHETER); A4610 - TRACHEAL SUCTION CATHETER/ANY TYPE OTHER THAN CLOSED SYSTEM ($1.76/ CATHETER); L8040 - NASAL PROSTHESIS ($1,352.99/INITIAL FITTING OR $1,285.34/REPLACEMENT INCLUDING NEW IMPRESSION/MOULAGE OR $541.18/ REPLACEMENT USING PREVIOUS MASTER MODEL); L8041 - MIDFACIAL PROSTHESIS ($1,630.81/INITIAL FITTING OR $1,549.26/REPLACEMENT INCLUDING NEW IMPRESSION/MOULAGE OR $541.18/REPLACEMENT USING PREVIOUS MASTER MODEL); L8042 - ORBITAL PROSTHESIS ($1,832.37/INITIAL FITTING OR $1,740.75/ REPLACEMENT INCLUDING NEW IMPRESSION/MOULAGE OR $732.95/REPLACEMENT USING A PREVIOUS MASTER MODEL).