RA Messages for July 5, 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:

PLEASE NOTE : LABELER 08290 (BD BECTON DICKINSON) WAS INCORRECTLY REPORTED AS TERMINATING THE REBATE AGREEMENT ON 7/1/00 INSTEAD OF BEGINNING COVERAGE ON 7/1/00.                                     

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

PHARMACY PROVIDERS:

EFFECTIVE 6/18/00, THE PROSPECTIVE DRUG UTILIZATION CLINICAL EDITS WILL NOW BE CREATED BY A NEW PROGRAM, UNIDUR. THE UNIDUR PROGRAM WILL GENERATE ALERT MESSAGES AS THE PRODUR PROGRAM. PHARMACISTS WILL RECEIVE A  UNIDUR PHARMACY PROVIDER HANDBOOK WHICH DETAILS THE UNIDUR MODULES. THE PBM HELP DESK (800-648-0790) WILL BE AVAILABLE TO RESPOND TO ANY QUESTIONS.

NOTICE TO HOME HEALTH AGENCIES

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2000, HOME HEALTH EXTENDED CARE SERVICES ARE TO BE BILLED WITH CODE X9902 AT AN HOURLY RATE OF $24.50. THERE WILL BE NO FIRST HOUR PAYMENT THAT IS DIFFERENT FROM THE ADDITIONAL HOURS. THE RATE HAS BEEN ADJUSTED TO COMPENSATE FOR THE COST OF EXTENDED CARE. ALSO, REMEMBER WHEN SERVICES ARE PROVIDED BY A PHYSICAL THERAPIST  ASSISTANT OR AN LPN, THESE SERVICES ARE TO BE IDENTIFIED BY USING THE NEW CODES, WHICH BECAME EFFECTIVE 2-1-00, WHEN REQUESTING PRIOR  AUTHORIZATION AND IN BILLING.  FOR FURTHER BILLING INSTRUCTIONS, PLEASE REFER TO THE PROVIDER NOTICE  DATED 01-24-00. 

NOTICE TO ALL PROVIDERS

THE DEPARTMENT PLANS TO REPROCESS CLAIMS AND REIMPLEMENT THE MEDICAID SPENDING REDUCTION PLAN AS DETAILED IN EMERGENCY RULES PUBLISHED IN FEBRUARY 2000. THE REPROCESSING OF CLAIMS WILL BEGIN WITH THE FIRST CHECKWRITE IN AUGUST FOR ALL CLAIMS PAID FROM 2/1/00 THROUGH 6/30/00. THEREFORE, DHH WILL BEGIN THE PROCESS OF COLLECTING THE DIFFERENCE  BETWEEN THE LOWER RATE STRUCTURE AND THE CURRENT HIGHER REIMBURSEMENT. THE REPROCESSING OF THESE CLAIMS IS NECESSARY DUE TO BUDGET PROBLEMS EARLIER THIS YEAR. DHH TRIES TO IMPOSE A 7% LOWER RATE STRUCTURE BEGINNING IN FEBRUARY AND MARCH. THESE NEW RATES WERE PUT ON HOLD BY A US DISTRICT COURT. BUT, DHH APPEALED THE COURT ACTION. IN MAY, THE 5TH CIRCUIT COURT OF APPEAL RULED IN THE DEPARTMENT'S FAVOR, THUS ALLOWING  DHH TO REIMPOSE THE LOWER RATE. THROUGHOUT THE COURT PROCEEDINGS AND THE MONTH OF JUNE, DHH REIMBURSED PROVIDERS AT THE HIGHER RATE.  IN ADDITION, BEGINNING WITH DATES OF SERVICE 7/1/00, DHH HAS REINSTATED THE RATES IN EFFECT PRIOR TO THE MEDICAID SPENDING REDUCTION PLAN  PUBLISHED IN FEBRUARY. THIS REINSTATEMENT APPLIES ONLY TO THE 7% LOWER  RATE STRUCTURE. 

NOTICE TO KIDMED AND COMMUNITY CARE PROVIDERS

EFFECTIVE IMMEDIATELY THE COMMUNITY CARE MONTHLY FEE REPORT (CP-0-92) AND THE SCREENING PROVIDER BENEFICIARY REPORT (RS-0-07), MONTHLY LISTINGS OF ALL RECIPIENTS LINKED, IS NOT A GUARANTEE OF RECIPIENT  ELIGIBILITY. THE CP-0-92 PROVIDES THE MOST UP-TO-DATE INFORMATION ON THE BENEFICIARY'S MEDICAID ELIGIBILITY FOR THE DATE THE REPORT WAS PRODUCED. TO ENSURE THAT THERE HAS NOT BEEN A CHANGE IN ELIGIBILITY STATUS SINCE THE REPORT WAS PRODUCED, YOU SHOULD ALWAYS CHECK THE BENEFICIARY'S 
000039 ELIGIBILITY STATUS THROUGH REVS OR MEVS BEFORE PROVIDING SERVICES.