RA Messages for July 13, 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 NOTE THE FOLLOWING CHANGES TO THE APPENDIX B:
| NDC |
TRADENAME |
DOSAGE |
| 00472-0511-12 |
HEMORRHOIDAL HC |
SUPP. RECT |
| 00472-0511-24 |
HEMORRHOIDAL HC |
SUPP. RECT |
| 00603-8127-11 |
HEMORRHOIDAL HC |
SUPP. RECT |
| 00603-8127-18 |
HEMORRHOIDAL HC |
SUPP. RECT |
| 51991-0078-01 |
SYNTEST H.S. |
TABLET |
| 51991-0079-01 |
SYNTEST H.S. |
TABLET |
| 63304-0408-12 |
PROCTOSOL HC |
SUPP. RECT |
| 63304-0408-24 |
PROCTOSOL HC |
SUPP. RECT |
| 66576-0230-01 |
SYNTEST H.S. |
TABLET |
| 66576-0231-01 |
SYNTEST H.S. |
TABLET |
PLEASE NOTE THE FOLLOWING CHANGES TO THE APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 00463 |
C.O.TRUXTON, INC. |
|
10/01/04 |
| 10135 |
MARLEX PHARMACEUTICALS, INC |
7/01/04 |
|
| 15127 |
SELECT BRAND DISTRIBUTORS |
|
10/01/04 |
| 25074 |
PENEDERM, INC |
|
10/01/04 |
| 50752 |
CREIGHTON PRODUCTS, CORP. |
|
10/01/04 |
| 52297 |
FOXMEYER DRUG COMPANY |
7/01/04 |
|
| 63252 |
RADFORD |
|
10/01/04 |
| 64727 |
RSJ, INC |
|
07/01/04 |
| 66733 |
IMCLONE SYSTEMS, INC |
1/01/04 |
|
| 68084 |
AMERICAN HEALTH PACKAGING |
10/01/04 |
|
| 68094 |
PRECISION DOSE, INC |
10/01/04 |
|
| 68135 |
BIOMARIN PHARMACEUTICALS, INC |
10/01/04 |
|
| 68516 |
INSTITUTO GRIFOLS |
7/01/04 |
|
PLEASE
FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
ATTENTION ALL DENTAL PROVIDERS
MEDICAID HAS IDENTIFIED A SYSTEM PROBLEM THAT CAUSED THE INCORRECT
DENIAL (840-EXACT DUPLICATE) OF DENTAL CLAIMS IN CASES WHERE THE PROVIDER REPORTED BOTH THE TOOTH NUMBER AND THE ORAL CAVITY DESIGNATOR
ON THEIR CLAIM. THE SYSTEM PROBLEM HAS BEEN CORRECTED AND MEDICAID WILL AUTOMATICALLY RECYCLE THE CLAIMS INVOLVED. THESE TRANSACTIONS WILL
APPEAR ON YOUR REMITTANCE ADVICE IN THE NEAR FUTURE. IF YOU HAVE ANY QUESTIONS RELATED TO THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER
RELATIONS BY CALLING (800)473-2783 OR (225)924-5040.
NOTICE TO PROVIDERS OF PROFESSIONAL
SERVICES
EFFECTIVE WITH THE INDICATED DATE OF SERVICE THE FOLLOWING
CPT CODES WILL BE ADDED TO THE LIST OF CODES WHICH REQUIRE A QW MODIFIER.
CPT 87899 EFFECTIVE 08-21-03
CPT 86701 EFFECTIVE 09-30-03
ATTENTION VISION (EYE WEAR) PROVIDERS
IN THE NEAR FUTURE, MEDICAID WILL AUTOMATICALLY RECYCLE
CLAIMS FOR EYE WEAR PROCEDURE CODES
THAT BEGIN WITH A "V" WHICH RECEIVED AN 813 (EXACT DUPLICATE) DENIAL
ON REMITTANCE ADVICES DATED MARCH 2, 2004 THROUGH MAY
25, 2004. THIS DENIAL OCCURRED AS A RESULT OF CLAIMS FOR THE SAME PROCEDURE
CODE BEING BILLED ON TWO SEPARATE CLAIM LINES. THIS RECYCLE WILL
OCCUR ONE TIME ONLY; THEREFORE, WHEN BILLING TWO UNITS OF A SINGLE PROCEDURE
CODE, PROVIDERS SHOULD REPORT THE TWO UNITS ON A SINGLE CLAIM LINE INDICATING
THE CORRECT NUMBER OF UNITS. THE ONLY INSTANCE IN WHICH TWO SEPARATE CLAIM LINES
ARE REQUIRED FOR A SINGLE PROCEDURE CODE IS FOR PROCEDURE CODE V2102 WHEN ONE
LENS REQUIRES PRIOR AUTHORIZATION AND ONE DOES NOT. IF YOU HAVE ANY QUESTIONS
REGARDING THIS MATTER, YOU MAY CONTACT
UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225)924-5040.
ATTENTION ALL DENTAL PROVIDERS
DUE TO SYSTEM PROBLEMS, SOME DENTAL CLAIMS THAT APPEARED ON
THE REMITTANCE ADVICES BETWEEN THE DATES OF MARCH 30, 2004 AND JUNE 1, 2004 THAT
DENIED WITH EOB 103(INVALID TOOTH CODE/ORAL CAVITY DESIGNATOR) MAY HAVE DONE SO
IN ERROR. PLEASE REVIEW THESE CLAIMS AND IF THEY WERE SUBMITTED WITH A CORRECT
TOOTH NUMBER/LETTER OR ORAL CAVITY DESIGNATOR, PLEASE RESUBMIT FOR REPROCESSING.
IF AN INVALID TOOTH NUMBER/LETTER OR ORAL
CAVITY DESIGNATOR WAS REPORTED, PLEASE CORRECT THIS INFORMATION AND RESUBMIT THE
CLAIM FOR REPROCESSING. ALSO, SOME PROVIDERS ARE STILL FILING CLAIMS USING ORAL
CAVITY DESIGNATOR (X,Y, UR, UL, LL, AND LR) WHICH WERE DISCONTINUED EFFECTIVE
MAY 1, 2003. PROVIDERS SHOULD BE USING THE ADA ORAL CAVITY DESIGNATORS AS
IDENTIFIED IN THE DENTAL SERVICES MANUAL
(ISSUE DATE MAY 1, 2003), PAGES 16-15 AND 16-16. SHOULD YOU HAVE ANY QUESTIONS
REGARDING THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS
BY CALLING (800)473-2783 OR (225)924-5040.
NOTICE TO PROVIDER OF PROFESSIONAL
SERVICES
CPT CODE 83880 WAS IN NON PAY STATUS AND ERRONEOUSLY LISTED
ON OUR FILES AS ASSAY NALORPHINE. CPT CODE 83880 (NATRIURETIC PEPTIDE) HAS BEEN
CORRECTED AND PLACED IN PAY STATUS EFFECTIVE WITH DATE OF SERVICE JANUARY 1,
2003.
CLAIMS WITH DATED OF SERVICE PAST ONE YEAR SHOULD BE
SUBMITTED HARD COPY WITH PROOF OF TIMELY FILING TO UNISYS PROVIDER RELATIONS.