RA Messages for April 13, 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.

PLEASE MAKE THE FOLLOWING CHANGES TO THE 3/01/04 VERSION OF APPENDIX A:

DRUG  DOSAGE STRGTH MAC EFF DATE
FOSINOPRIL TABLET  10MG  1.18977 04/01/04
FOSINOPRIL TABLET  20MG 1.18977 04/01/04
FOSINOPRIL TABLET  40MG 1.18977 04/01/04
NEFAZODONE HCL TABLET 50MG 1.50283  04/01/04
NEFAZODONE HCL TABLET 100MG 1.53892 04/01/04
NEFAZODONE HCL TABLET 150MG 1.56792 04/01/04
NEFAZODONE HCL TABLET 200MG  1.59742 04/01/04
NEFAZODONE HCL TABLET 250MG 1.62716  04/01/04

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

ATTENTION ALL PROVIDERS

THE BACK OF THE RECIPIENT'S MEDICAID PLASTIC ID CARD CONTAINS A PHONE NUMBER FOR THE RECIPIENT TO CONTACT FOR QUESTIONS ABOUT THE MEDICAID CARE OR THE MEDICAID PROGRAM. THE CORRECT TELEPHONE NUMBER FOR THESE CALLS IS 1-800-834-3333.  WHEN ASSISTING YOUR MEDICAID PATIENTS, PLEASE ENSURE THAT YOU PROVIDE THEM WITH THIS NUMBER, AND DISCARD ANY AND ALL OTHER TELEPHONE NUMBERS YOU MAY HAVE FOR THIS PURPOSE.

ATTENTION DME, MENTAL HEALTH REHAB, AND WAIVER PROVIDERS

DURING THE MARCH 1, 2004 HIPAA IMPLEMENTATION FOR DME AND MENTAL HEALTH REHABILITATION, A PRIOR AUTHORIZATION FILE EDIT ERROR WAS DISCOVERED. THE ERROR WAS CORRECTED AND CLAIMS INVOLVED WERE RECYCLED. WHILE RESOLVING THE INITIAL PROBLEM, THE CLAIMS PROCESSED ON MARCH 11, 2004 INCURRED AN ADDITIONAL PROCESSING ERROR AND EITHER PAID WHEN THEY SHOULD HAVE DENIED OR PAID ERRONEOUS PAYMENTS. THIS ADDITIONAL PROCESSING ERROR AFFECTED DME, MENTAL HEALTH REHABILITATION AND WAIVER CLAIMS. THIS PROBLEM WAS CORRECTED AND ADJUSTMENTS OR VOIDS ARE PROCESSED AS APPROPRIATE ON THE APRIL 13, 2004 REMITTANCE ADVICE. 

ATTENTION ALL MEDICAID PROVIDERS

AS OF DECEMBER 1, 2003, THE COMMUNITYCARE PROGRAM HAS BEEN IMPLEMENTED STATEWIDE. APPROXIMATELY 80% OF ALL MEDICAID ELIGIBLES ARE ENROLLED IN COMMUNITYCARE AND ARE LINKED TO A COMMUNITYCARE PRIMARY CARE PHYSICIAN (PCP). THEREFORE, THE COMMUNITYCARE PROGRAM IMPACTS THE REIMBURSEMENT AND PRACTICE OF ALL MEDICAID PROVIDERS IN EVERY AREA OF THE STATE, NOT JUST COMMUNITYCARE-ENROLLED PCPS. ALL MEDICAID PROVIDERS SHOULD BECOME FAMILIAR WITH THE PROGRAM, AND READ ALL REMITTANCE MESSAGES AND PROVIDER UPDATE ARTICLES CONCERNING COMMUNITYCARE. 

PROVIDERS CAN FIND OUT WHICH PCP A PATIENT IS LINKED TO WHEN THEY CHECK THE PATIENT'S MEDICAID ELIGIBILITY USING ANY OF THE MEDICAID ELIGIBILITY VERIFICATION SYSTEMS, IE; REVS, MEVS AND THE WEB APPLICATION (EMEVS). THIS INFORMATION SHOULD ALWAYS BE CHECKED PRIOR TO PROVIDING NON- EMERGENT SERVICES TO ANY MEDICAID RECIPIENT. IF THERE IS NOT A PCP LISTED, THEN THE PATIENT IS NOT IN COMMUNITYCARE, AND A PCP REFERRAL IS NOT NEEDED.