RA Messages for February 24, 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.

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).

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

CPT CODE 92065 (ORTHOPTIC AND/OR PLEOPTIC TRAINING, WITH CONTINUING MEDICAL DIRECTION AND EVALUATION) CAN ONLY BE BILLED IF THE PLACE OF SERVICE (POS=11) IS THE PHYSICIAN'S OPTOMETRIST'S OFFICE AND PERFORMED 1 ON 1 WITH THE PATIENT.

ATTENTION ALL AMBULANCE PROVIDERS

DURING THE REQUIRED HIPAA CONVERSION FOR THE AMBULANCE TRANSPORTATION PROGRAM AN ERROR WAS MADE WHILE IMPLEMENTING THE NEW 837P ELECTRONIC CLAIMS TRANSACTION SPECIFICATION.  THIS ERROR CAUSED SOME AMBULANCE CLAIMS SUBMITTED FOR PAYMENT SINCE OCTOBER 2003 TO BE PROCESSED AS EMERGENCY AMBULANCE CLAIMS WHEN THEY SHOULD HAVE BEEN PROCESSED AS NON-EMERGENCY AMBULANCE CLAIMS. AS A RESULT, SOME CLAIMS DENIED IN ERROR; SOME CLAIMS PAID IN ERROR; AND SOME CLAIMS WERE OVERPAID.  DHH IS RECYCLING THESE CLAIMS AND ADJUSTING THEM APPROPRIATELY  FOR FINAL ADJUDICATION.  THIS MAY RESULT IN A DECREASE IN PAYMENT ON THOSE CLAIMS THAT OVERPAID AND THOSE CLAIMS THAT SHOULD HAVE DENIED. THIS RECYCLE WILL OCCUR ON THE 2/24/04 RA. QUESTIONS MAY BE DIRECTED TO PROVIDER RELATIONS AT (800) 473-2783 OR (225) 924-5040.