RA Messages for June 6, 2000
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 5/15/00 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| AMYLASE/LIPASE/PROTEASE |
TAB |
60-16-60 |
|
04/20/00 |
| CIMETIDINE |
TABLET |
200MG
|
0.13280 |
08/01/00 |
| CITALOPRAM
HYDROBROMIDE |
SOL |
10MG/5ML |
|
04/03/0
0 |
| CODEINE PHOS/APAP |
TAB |
30-300MG 1000'S |
0.09770 |
09/30/97 |
| FUROSEMIDE |
SOL |
10MG/ML120ML |
0.08930 |
08/01/00 |
| GLYBURIDE |
TAB |
1.5MG |
0.25500 |
08/01/00 |
| GLYBURIDE |
TAB |
6MG |
0.74280 |
08/01/00 |
| KETOCONAZOLE |
TAB |
200MG (OTH SIZES) |
2.76450 |
08/01/00 |
| NIACIN (RX ONLY) |
TAB |
500MG
1000'S |
0.01590 |
08/01/00 |
| OXYCODONE HCL |
TAB.SR 12H |
160MG |
|
04/17/00 |
| PREDNISOLONE SOD
PHOS |
POWDER |
|
|
12/30/99 |
| PRIMIDONE |
TAB |
250MG
1000'S |
0.33000 |
08/01/00 |
| PROCAINAMIDE HCL |
TAB.SR 12H |
1000MG |
|
04/06/00 |
| RIVASTIGMINE
TARTRATE |
CAP |
1.5MG |
|
04/26/00 |
| RIVASTIGMINE
TARTRATE |
CAP |
3
MG |
|
04/26/00 |
| RIVASTIGMINE
TARTRATE |
CAP |
4.5MG |
|
04/26/00 |
| RIVASTIGMINE
TARTRATE |
CAP |
6 MG |
|
04/26/00 |
| SERTRALINE HCL |
ORAL CONC |
20MG/ML |
|
04/05/00 |
| TIMOLOL MALEATE |
DROPS |
0.5% |
0.91500 |
08/01/00 |
PLEASE MAKE THE FOLLOWING
CHANGES TO THE 5/15/00 VERSION OF APPENDIX C:
| LABELER |
NAME |
BEGIN |
END |
| 08290 |
BD BECTON DICKINSON |
|
07/01/00 |
| 37937 |
MEDALIST |
|
10/01/00 |
| 54921 |
IPR PHARMACEUTICALS, INC
|
|
07/01/00 |
| 57783 |
BRISTOL-MEYERS SQUIBB COMPANY
|
|
07/01/00 |
| 60242 |
NEIL LABORATORIES, INC |
07/01/00 |
|
| 62174 |
PROMETIC PHARMA USA, INC |
|
07/01/00 |
| 62436 |
BIOGLAN PHARMA, INC |
|
07/01/00 |
| 64836
|
WOMEN'S CAPITAL CORPORATION |
|
07/01/00 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.
PHARMACISTS AND PRESCRIBING
PROVIDERS
RECENTLY, THE APPENDICES FOR PROVIDER MANUALS
WERE MAILED TO YOU. APPENDIX A INCLUDED
ADDITIONS, DELETIONS AND REVISIONS TO THE FEDERAL
UPPER LIMITS WHICH BECOME EFFECTIVE ON JUNE 1, 2000. WE HAVE RECEIVED
NOTIFICATION FROM THE HEALTH CARE FINANCING
ADMINISTRATION TO DELAY THE
IMPLEMENTATION OF THE JUNE 1 FEDERAL UPPER
LIMITS TO AUGUST 1, 2000. THEREFORE, THE GENERIC DESCRIPTIONS WITH JUNE 1 PRICES LISTED
IN APPENDIX A WILL NOT BE
IMPLEMENTED UNTIL AUGUST 1 OR OTHERWISE DIRECTED
BY HCFA.
NOTICE TO HOSPITALS AND HOME HEALTH
AGENCIES
WE REALIZE, DUE TO THE EVERGREEN VS. DHH CASE, WE HAVE
NOTIFIED HOSPITALS OF DIFFERENT SPLIT-BILLING PROCEDURES FOR DATES OF SERVICE
MARCH 1, 8, AND 23 OF 2000, AS WELL AS NOTIFYING HOME HEALTH AGENCIES OF
DIFFERENT PROCEDURES FOR REQUESTING PA AND BILLING OF HOME HEALTH SERVICES
BEGINNING WITH DATES OF SERVICE 2/1/00. DUE TO RECENT DEVELOPMENTS IN THIS
CASE, UPON RECEIPT OF THIS NOTICE, BILLING PROCEDURES ARE AS FOLLOWS:
ALL LONG TERM CARE HOSPITALS AND ALL PRIVATE AND PUBLIC
PSYCHIATRIC HOSPITALS, INCLUDING PSYCHIATRIC UNITS WITHIN PRIVATE AND PUBLIC
ACUTE CARE HOSPITALS (EXCEPT CHARITY HOSPITALS) WILL BE REQUIRED TO SPLIT-BILL
MEDICAID INPATIENT CLAIMS CASED ON DOS EFFECTIVE MARCH 8 AND 23, 2000. HOME
HEALTH AGENCIES - FOR DOS 2/1/00 THROUGH 3/22/00, THE PROCEDURES FOR REQUESTING
PA AND BILLING ARE THOSE OUTLINES IN OUR PROVIDER NOTICE DATED 1/24/2000. IN
SHORT, DURING THESE DOS ONLY, THE FIRST HOUR OF EXTENDED CARE MUST BE INCLUDED
IN THE PA REQUEST FOR EXTENDED CARE FOR RECIPIENTS TO AGE 21. THE FEES DURING
THOSE DOS ARE ALSO INCLUDED IN THIS NOTICE. FOR DOS 3/23/00 FORWARD, THE
PROCEDURES FOR REQUESTING PA AND BILLING FOR THE 1ST HOUR OF EXTENDED ARE
REMAINS THE SAME AS THOSE IN PLACE PRIOR TO 2/1/00, WHEN SERVICES ARE PROVIDED
BY A PHYSICAL THERAPIST ASSISTANT OR AN LPN, THESE SERVICES ARE TO BE
INDENTIFIED BY USING THE NEW CODES WHEN REQUESTING PA AND IN BILLING.
WE ARE SORRY FOR THE INCONVEINEINCE. CONTACT UNISYS
PROVIDER RELATIONS AT (800) 473-2783 OR (225) 924-5040 IF FURTHER ASSISTANCE IS
REQUIRED.