RA Messages for February 22, 2000
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 |
| BUDESONIDE |
SPRAY |
32MCG |
|
01/10/00 |
| BUSPIRONE HCL |
TABLET |
30MG |
|
01/19/00 |
| DOFETILIDE |
CAPSULE |
0.125,0.25,0.5MG |
|
01/21/00 |
| EXEMESTANE |
TABLET |
25MG |
|
01/05/00 |
| FENOFIBRATE,MICRONIZED |
CAPSULE |
134MG |
|
01/06/00 |
| GABAPENTIN |
TABLET |
600MG;800MG |
|
01/10/00 |
| GATIFLOXACIN |
TABLET |
400MG |
|
01/19/00
|
| ITRACONAZOLE |
KIT |
250MG |
|
01/24/00 |
| MOXIFLOXACIN |
TABLET |
400MG |
|
12/15/99 |
| NEDOCROMIL SODIUM |
DROPS |
2% |
|
02/01/00 |
| NEOMYCIN SULF |
TABLET |
500MG |
0.51690 |
02/10/00 |
| NITROGLYCERIN |
SPRAY |
|
|
01/19/00 |
| OXCARBAZEPINE |
TABLET |
150MG;300MG;600MG |
|
01/17/00 |
| PROGESTERONE |
CAPSULE |
200MG |
|
11/01/99 |
| RESERPINE |
TABLET |
0.25MG |
0.22389 |
02/10/00 |
| TRIMETHOPRIM |
SOLUTION |
50MG/ML |
|
02/07/99 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
RURAL HEALTH CLINICS
RURAL HEALTH CLINICS HAVE NEW LICENSING REQUIREMENTS AS OF OCTOBER 20, 1999. THESE REQUIREMENTS MAY SUPERCEDE PREVIOUS POLICY. RHC'S SHOULD
TAKE STEPS TO ENSURE THE NEW STANDARDS AS FOLLOWED.
ATTENTION HOME HEALTH PROVIDERS
YOU RECENTLY RECEIVED A LETTER CONCERNING BILLING AND PAYMENT CHANGES IN THE HOME HEALTH PROGRAM. AMONG THE CHANGES IS A REQUIREMENT THAT WHEN
REQUESTING PRIOR AUTHORIZATION FOR EXTENDED NURSING CARE, THE FIRST HOUR OF CARE MUST NOW BE INCLUDED WITH THE PRIOR AUTHORIZATION REQUEST. FOR EXTENDED NURSING CARE PAS ONLY, THIS MEANS THAT YOU MUST FILE A
RECONSIDERATION FOR ANY PAS PREVIOUSLY APPROVED THAT CONTAIN DATES OF SERVICE FEBRUARY 1, 2000 AND AFTER IN ORDER TO RECEIVE APPROVAL FOR THE TOTAL NUMBER OF HOURS TO BE PROVIDED WITHIN THE SPAN DATES OF THE PA. YOU SHOULD SUBMIT A COPY OF THE PREVIOUSLY APPROVED PA LETTER AND A CORRECTED PA-07 SHOWING THE TOTAL NUMBER OF HOURS TO BE PROVIDED WITHIN THE SPAN DATES ON THE PA (EVEN IF SOME OF THESE HOURS HAVE ALREADY BEEN PROVIDED). PLEASE INDICATE ON THE CORRECTED PA-07 EXACTLY HOW MANY HOURS PER DAY AND HOW MANY DAYS PER WEEK ARE BEING REQUESTED. THE HOURS
NEEDED TO ACCOMMODATE THE NEW BILLING PROCEDURE WILL BE CALCULATED UNDER THE SAME PA NUMBER. YOU WILL RECEIVE A NEW PA APPROVAL LETTER FOR
THAT PA NUMBER