RA Messages for April 8, 2003

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 1/01/02 VERSION OF APPENDIX A:

DRUG DOSAGE STRGTH  MAC EFF DATE 
ACETYLSTEINE VIAL 100MG/ML OFF MAC     04/07/03 
GEMFIBROZIL TAB 600MG $0.30580  04/07/03 
GLYBURIDE TAB 1.25MG OFF MAC 04/07/03 
GLYBURIDE TAB 2.5MG OFF MAC 04/07/03 
GLYBURIDE TAB 5MG OFF MAC 04/07/03 
GRISEOFULVIN,MICROSIZE TAB 500MG OFF MAC  02/01/03 
HYDROCORTISONE ACETATE/UREA CR TOP 1% OFF MAC  01/01/03 
HYDROXYZINE PAMOATE CAP 50MG $0.11780 04/07/03
LINDANE SHAMPOO 1% OFF MAC 01/01/03
LOXAPINE SUCCINATE CAP 5MG  OFF MAC 01/01/03
LOXAPINE SUCCINATE CAP 10MG OFF MAC 01/01/03
LOXAPINE SUCCINATE CAP 25MG OFF MAC 01/01/03
LOXAPINE SUCCINATE CAP 50MG OFF MAC 01/01/03
MEPROBAMATE TAB  400MG  OFF MAC 02/01/03
NYSTATIN  (*ALL SIZES) OS  100MU/ML  $0.17570 12/01/02 

                       

          

PLEASE MAKE THE FOLLOWING CHANGES TO THE 1/01/02 VERSION OF APPENDIX C:

LABELER COMPANY BEGIN   END
00462 PHARMADERM    7/01/03  
49614 MEDICINE SHOPPE INT'L  7/01/03  
63020 MILLENNIUM PHARMACEUTICALS, INC 7/01/03  
66435 THREE RIVERS PHARMACEUTICALS 7/01/03  
66860 CURA PHARMACEUTICAL CO. INC 7/01/03  
66934 INKINE PHARMACEUTICALS 7/01/03  
67523 ABER PHARMACEUTICALS, INC 7/01/03  

  

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

ATTENTION ALL PROVIDERS

THE PROVIDER ENROLLMENT UNIT HAS A NEW PHONE NUMBER. IT IS 225-237-3370. 

ATTENTION 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.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

CORRECTION

THE REMITTANCE ADVICE OF JANUARY 14, 2003 AND JANUARY 21, 2003 STATED THAT THE FEE FOR THE MIRENA IMPLANT (J7302) WOULD INCREASE EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2003.  DUE TO AN ERROR THE FEE WAS NOT INCREASED UNTIL MARCH 14, 2003.  ADJUSTMENTS MAY BE SUBMITTED FOR THE DIFFERENCE BETWEEN THE OLD AND NEW RATES. WE APOLOGIZE FOR ANY INCONVENIENCE THIS MAY HAVE CAUSED.

NOTICE TO PHYSICIANS, ANESTHESIOLOGISTS, AND HOSPITALS

SUBMISSION FOR CHARGES RELATED TO STERILIZATION PERFORMED WHEN THE CONSENT WAS NOT OBTAINED THIRTY DAYS PRIOR TO THE STERILIZATION MUST INCLUDE DOCUMENTATION TO CONFIRM THE EXPECTED DATE OF DELIVERY IN ADDITION TO THE CONSENT FORM WITH THE ESTIMATED DATE OF DELIVERY OR ESTIMATED DATE OF CONFINEMENT INDICATED IN THE PROPER AREA.

NOTICE TO ALL PROVIDERS

PRESCRIPTIONS FOR ENTERAL FORMULA OR OTHER PRIOR AUTHORIZED SERVICES REQUIRE A REFERRAL IF THE PATIENT IS LINKED TO A PCP IN THE COMMUNITYCARE PROGRAM. PROVIDERS COORDINATING CARE FOR PATIENTS WITH SERIOUS MEDICAL CONDITIONS SUCH AS CANCER, END STAGE RENAL DISEASE, OR HIV SHOULD THUS OBTAIN THE COMMUNITYCARE REFERRAL, WHICH MAY BE PASSED ON TO OTHER PROVIDERS TREATING THE PATIENT FOR THIS CONDITION. REFERRALS FOR SERIOUS AND CHRONIC MEDICAL CONDITIONS MAY BE GIVEN FOR A PERIOD OF TIME OF ONE YEAR. QUESTIONS REGARDING THIS MATTER MAY BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 1-800-473-2783.

IMPORTANT MESSAGE TO ALL COMMUNITYCARE PROVIDERS

SOME CONCERNS HAVE BEEN EXPRESSED BY PROVIDERS THAT COMMUNITYCARE PCPS ARE NOT GRANTING REFERRALS IN A TIMELY MANNER. ALL COMMUNITYCARE PCPS SHOULD REVIEW CAREFULLY ANY REQUEST FOR A REFERRAL AND RESPOND TIMELY. IF THE COMMUNITYCARE PCP FEELS THAT THE ORIGINAL REQUEST DOES NOT CONTAIN ADEQUATE INFORMATION, HE/SHE MAY REQUEST ADDITIONAL INFORMATION BEFORE MAKING A FINAL DECISION TO GRANT OR TO DENY THE REFERRAL. A RESPONSE TO ALL REQUESTS FOR REFERRALS SHOULD BE GIVEN WITHIN TEN DAYS OF RECEIPT OF THE REQUEST, AS SPECIFIED IN SECTION 9.1.2 OF THE COMMUNITYCARE HANDBOOK. QUESTIONS ABOUT THESE REFERRALS MAY BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 1-800-473-2783.