RA Messages for February 26, 2002

 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 1/1/02 VERSION OF APPENDIX A:

DRUG DOSAGE STRGTH MAC EFF. DATE
ALBUTEROL SULFATE TABLET 2MG 0.0477 03/05/02
ALBUTEROL SULFATE TABLET 4MG 0.0900 03/05/02
ALLOPURINOL TABLET 100MG 0.0784 03/05/02
AMITIPTYLINE TABLET 10MG 0.0570 03/05/02
AMOXICILLIN TRIHYDRATE SUSP RECON 125MG/5ML  150ML 0.0201 03/05/02
AMOXICILLIN TRIHYDRATE TAB CHEW 250 MG 0.1595 01/22/02
ATENOLOL TABLET 100MG 0.0750 03/05/02
BENZTROPINE MESYLATE TABLET 1MG 0.0930 01/10/02
BENZTROPINE MESYLATE TABLET 1MG 0.1403 03/05/02
BENZTROPINE MESYLATE TABLET 2MG 0.1767 03/05/02
CIMETIDINE LIQUID 300MG/5ML 0.1139 03/05/02
FUROSEMIDE TABLET 20MG 0.0563 03/05/02
FUROSEMIDE TABLET 40MG 0.05915 03/05/02
HYDROCORTISONE LOTION 2.5% 59 ML 0.68140 01/22/02
ISOSORBIDE MONONITRATE TABLET 20MG 0.4950 03/05/02
METHANAMINE HIPPURATE TABLET 1GM OFF MAC 03/05/02
METHANAMINE MANDELATE TABLET 1GM 0.2923 03/05/02
NAPROXEN TABLET 500MG 0.1792 03/05/02
NEOMY SULF/POLYMYX B SULF/HC DROPS SUSP OFF MAC 02/26/02
NYSTATIN ORAL SUSP 100MU/ML 0.08500 01/22/02
PRIMIDONE TABLET 250MG 0.3798 03/05/02
PROMETHAZINE HCL INJ 50MG/ML OFF MAC 01/10/02
PROPANOLOL HCL TABLET 20MG 0.07050 01/22/02
PROPANOLOL HCL TABLET 40 MG 0.08480 01/22/02
PROPANOLOL HCL TABLET 60MG OFF MAC 02/26/02

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

ALL MEDICAID PROVIDERS

EFFECTIVE NOVEMBER 15, 2001, HEMODIALYSIS SERVICES ARE EXEMPT FROM THE COMMUNITYCARE REFERRAL PROCESS. QUESTIONS REGARDING THIS CHANGE MAY BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 800-473-2783.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF PAY 2-18-02, PAYMENT FOR A SECOND COMPLETE SONOGRAM PER RECIPIENT WILL BE ALLOWED WITHIN A 270 DAY PERIOD WHEN PERFORMED BY A DIFFERENT PROVIDER.

A CLAIM MUST HAVE A DIAGNOSIS OTHER THAN V22, V22.0, V22.1, OR V22.2, BE BILLED HARDCOPY, AND HAVE ATTACHMENTS JUSTIFYING MEDICAL NECESSITY IN ORDER TO PEND FOR MEDICAL REVIEW.

NO CHANGES WERE MADE TO REMAINING PARTS OF THIS POLICY.