RA Messages for June 10, 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 B:

NDC TRADENAME DOSAGE
66993-0601-02 MIGRIN-A CAPSULE

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

PHARMACY PROVIDERS

EFFECTIVE MAY 30, 2003, DENY CLAIM FACSIMILES WILL NO LONGER BE GENERATED AND MAILED WITH THE RA TO PHARMACY PROVIDERS FOR THE FOLLOWING POS DENY EDIT CODES:

485 - PA REQUIRED
486 - RA EXPIRED
498 - NO OF RX GREATER THAN LIMIT
575 - MISSING OR INVALID ICD-9 CODE
576 - MISSING OR INVALID PA/MC CODE

ATTENTION HOME AND COMMUNITY-BASED WAIVER SERVICES PROVIDERS

FOR INFORMATION ABOUT HOME AND COMMUNITY-BASED WAIVER SERVICES AS AN 
ALTERNATIVE LONG TERM CARE OPTION, PLEASE CALL 1-800-660-0488.

DISCONTINUATION OF WHEELCHAIR SEATING EVALUATION CODE

EFFECTIVE SEPTEMBER 1, 2003, PROCEDURE CODE Y7902 FOR WHEELCHAIR SEATING EVALUATION WILL BE PUT IN NON-PAY STATUS. PROVIDERS OF THIS SERVICE MUST USE PROCEDURE CODE Y7702 IS A PHYSICAL THERAPIST DOES THE EVALUATION, AND PROCEDURE CODE Y7812 IF AN OCCUPATIONAL THERAPIST DOES THE EVALUATION. THE PHYSICAL THERAPY EVALUATION  IS REIMBURSED AT THE RATE OF $54.00 AND THE OCCUPATIONAL THERAPY EVALUATION IS REIMBURSED AT THE RATE OF $51.00.  WHEN BILLING FOR THESE SERVICES, PROVIDERS MUST SUBMIT A PRESCRIPTION FROM A PHYSICIAN IN ORDER TO RECEIVE REIMBURSEMENT.