RA Messages for April 6, 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 MAKE THE FOLLOWING CHANGES TO THE 3/01/04 VERSION OF
APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 00451 |
MURO PHARMACEUTICALS, INC |
|
04/01/04 |
| 53807 |
RIJ PHARMACEUTICAL CORPORATION |
04/01/04 |
|
| 60977 |
BAXTER HEALTHCARE CORPORATION |
07/01/04 |
|
| 61073 |
AMKAS LABORATORIES, INC |
04/01/04 |
|
| 61379 |
GUILFORD PHARMACEUTICALS, LTD |
07/01/04 |
|
| 63044 |
NNODUM CORPORATION |
04/01/04 |
|
| 63672 |
SYNTHON PHARMACEUTICALS, LTD |
07/01/04 |
|
| 67836 |
MOREPEN MAX, INC |
07/01/04 |
|
| 68025 |
VERTICAL PHARMACEUTICALS, INC |
07/01/04 |
|
| 68040 |
PRIMUS PHARMACEUTICALS, INC |
07/01/04 |
|
| 68158 |
PRAECIS PHARMACEUTICALS, INCORPORATED |
07/01/04 |
|
| 68322 |
ALAMO PHARMACEUTICALS LLC |
07/01/04 |
|
| 68549 |
CORBAN PHARMACEUTICALS, LLC |
04/01/04 |
|
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN
INCORRECTLY PAID.
ATTENTION EPSDT HEALTH SERVICES PROVIDERS
DURING THE MOST RECENT PHASE OF HIPAA IMPLEMENTATION EPSDT HEALTH SERVICES CLAIMS FOR CODES 97110 AND 97530 WERE ERRONEOUSLY DENIED WITH EDIT 191 (PROCEDURE REQUIRES PRIOR AUTHORIZATION). THESE CLAIM DENIALS HAVE BEEN RECYCLED AND PROCESSED ON THE MARCH 23, 2004 RA. QUESTIONS SHOULD BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 800-473-2783 OR 225-924-5040.
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 PROVIDERS
PAYMENT FOR BOTH OPEN AND CLOSED SYSTEM CATHETERS HAVE BEEN AUTHORIZED/BILLED
USING PROCEDURE CODE A4624 AND ALL FACIAL PROSTHETICS HAVE BEEN
AUTHORIZED/BILLED USING PROCEDURE CODE L8499. EFFECTIVE IMMEDIATELY, THE
FOLLOWING HIPAA COMPLIANT PROCEDURE CODES SHOULD BE USED: A4609 - TRACHEAL
SUCTION CATHETER/LESS THAN 72 HOURS IN USE IN A CLOSED SYSTEM @ $10.01/CATHETER.
A6410 - TRACHEAL SUCTION CATHETER/72 HOURS OR MORE OF USE @ $15.64/CATHETER.
A4624 - TRACHEAL SUCTION CATHETER/ANY TYPE OTHER THAN A CLOSED SYSTEM @
$1.76/CATHETER. L8040 - NASAL PROSTHESIS @1,352.99/INITIAL FITTING,
$1,285.34/REPLACEMENT WITH NEW IMPRESSION/MOULAGE OR $541.18 REPLACEMENT USING
PRIOR MASTER MODEL. L8041 - MIDFACIAL PROSTHESIS @1,630.81/INITIAL FITTING,
$1,549.26/REPLACEMENT WITH NEW IMPRESSION/MOULAGE OR $541.18 REPLACEMENT USING A
PRIOR MASTER MODEL. L8042 - ORBITAL PROSTHESIS @1,832.37/INITIAL FITTING,
$1,740.75/REPLACEMENT WITH NEW IMPRESSION/MOULAGE OR $732.95/REPLACEMENT USING A
PRIOR MASTER MODEL.