RA Messages for March 20, 2001
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 FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.
ATTENTION ALL OPTICAL SUPPLIERS
CLARIFICATION OF SPECIALTY EYE WEAR POLICY
ALL PRIOR AUTHORIZATION REQUESTS BILLED UNDER THE PROCEDURE CODE X0089 FOR
SPECIALTY EYE WEAR (I.E., CONTACT LENSES, SPECIAL LENSES, SPECIAL FRAMES, ETC.),
MUST BE ACCOMPANIED BY A STATEMENT OF MEDICAL NECESSITY FROM THE PRESCRIBING
PHYSICIAN IN ORDER FOR A PRIOR AUTHORIZATION DECISION TO BE RENDERED. THE
MEDICAL NECESSITY STATEMENT MUST BE SPECIFIC TO EACH INDIVIDUAL REQUEST.
NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES
CPT CODE 99431 (HISTORY AND EXAMINATION OF THE NORMAL NEWBORN INFANT, ETC.) MUST BE PERFORMED ON THE SAME DATE AS THE CHILD'S BIRTH OR WITHIN
THE FIRST TWENTY-FOUR HOURS OF THE CHILD'S LIFE.