RA Messages for June 15, 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.
ON THE TAPE OF 3/8/04, FIRST DATABANK CHANGED THE SIZE AND UNITS
OF RISPERDAL, (50458-0306-11, -0307-11
AND -0308-11) FROM 2(ML) TO 1(UNIT) BUT THEY DID NOT CHANGE THE PRICE UNTIL THE
FOLLOWING WEEK. SO, FOR ONE WEEK CLAIMS FOR THESE NDCS COULD HAVE PAID
INCORRECTLY. PLEASE SUBMIT ADJUSTMENTS IF
NECESSARY.
PLEASE MAKE THE FOLLOWING CHANGES TO THE 5/01/04 VERSION OF
APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 00058 |
NOVARTIS PHARMACEUTICALS CORPORATION |
|
07/01/04 |
| 00369 |
SCHERING CORPORATION |
|
07/01/04 |
| 00372 |
SCOT-TUSSIN PHARMACAL COMPANY, INC. |
|
07/01/04 |
| 00514 |
BERTEK PHARMACEUTICALS, INC. |
|
07/01/04 |
| 52316 |
DSC LABORATORIES DIV DSC PRODUCTS, INC. |
|
07/01/04 |
| 53706 |
DELTA PHARMACEUTICALS, INC. |
04/01/04 |
|
| 53807 |
RIJ PHARMACEUTICAL CORPORATION |
|
07/01/04 |
| 57267 |
NOVARTIS PHARMACEUTICALS CORPORATION |
|
07/01/04 |
| 57459 |
NASTECH PHARMACEUTICAL COMPANY |
|
07/01/04 |
| 58887 |
NOVARTIS
PHARMACEUTICALS CORPORATION |
|
07/01/04 |
| 60242 |
NEIL LABORATORIES, INC |
07/01/04 |
|
| 61113 |
ASTRA ZENECA PHARMACEUTICALS |
|
07/01/04 |
| 61392 |
HEARTLAND SERVICES |
|
07/01/04 |
| 61953 |
GRIFOLS BIOLOGICALS, INC. |
07/01/04 |
|
| 63955 |
GYNETICS |
|
07/01/04 |
| 64248 |
WOMEN'S FIRST HEALTH CARE |
|
07/01/04 |
| 67618 |
PURDUE PRODUCTS, L.P. |
07/01/04 |
|
| 67857 |
REDDY PHARMACEUTICALS |
|
07/01/04 |
| 68180 |
LUPIN PHARMACEUTICALS, INC |
07/01/04 |
|
| 68669 |
VISTAKON PHARMACUTICALS LLC |
07/01/04 |
|
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
ATTENTION REHABILITATION CENTER PROVIDERS
THE BUREAU OF HEALTH SERVICES FINANCING ANNOUNCES THAT EFFECTIVE IMMEDIATELY, REHABILITATION CENTERS WILL BE ALLOWED TO PROVIDE SPEECH,
OCCUPATIONAL, AND PHYSICAL THERAPY SERVICES IN THE HOMES OF RECIPIENTS WITH PRIOR
APPROVAL FROM THE UNISYS PRIOR AUTHORIZATION UNIT. A RECIPIENT'S PLACE OF RESIDENCE, FOR THESE SERVICES, DOES NOT INCLUDE A
NURSING HOME. REIMBURSEMENT WILL BE MADE AT 110% OF THE CURRENT APPROVED RATE FOR REHABILITATION CENTERS. REQUESTS FOR SERVICES SHOULD BE
SUBMITTED ON UNISYS FORM 101. SERVICES SHOULD BE BILLED WITH UNISYS FORM
102.THE PLACE OF SERVICE FOR HOME MUST BE INDICATED ON THE PA REQUEST AND ON THE CLAIM.
ATTENTION PHYSICIANS
CLAIMS FOR PROCEDURE CODE Z9005 THAT WERE POSTING ERROR 743 (MAX OF TWO PER
PREGNANCY EXCEEDED) ERRONEOUSLY ARE BEING RECYCLED FOR PAYMENT IN THE 6/15/04
PAYMENT CYCLE.
ATTENTION PHYSICIANS
CLAIMS FOR PROCEDURE CODE 99201-99205 AND 99211-99215 WITH "TH"
MODIFIER WERE INCORRECTLY PRICED AT THE ENHANCED RATE DUE TO A SYSTEM
PROBLEM. SOME OF THESE CLAIMS WERE ALSO DENIED ERRONEOUSLY FOR ERROR 702
(NEW PATIENT/ESTABLISHED PATIENT CODE CONFLICT). THE CLAIMS FOR THESE PROCEDURE
CODES ARE BEING RECYCLED/ADJUSTED FOR CORRECT PAYMENT IN THE 6/15/04 PAYMENT
CYCLE.