RA Messages for July 6, 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 HOME HEALTH PROVIDERS
PRIOR TO HIPAA, WHEN AN AGENCY BILLED FOR EXTENDED SKILLED
NURSING SERVICES (HOME HEALTH), AGENCIES USED THE CODES X9902 AND X9907
(MULTI-RECIPIENTS). IT DID NOT MATTER WHO PERFORMED THE SERVICE, RN OR LPN, AS
THEY WERE PAID AT THE SAME RATE.
WITH HIPAA, MEDICAID MAPPED TO 2 SEPARATE CODES (S9123 FOR RN
AND S9124 FOR LPN). THE ONLY TIME AN AGENCY NEEDS TO USE A MODIFIER IS IF THERE
ARE MULTI-RECIPIENTS. AT THE TIME, THE AGENCY WOULD REQUEST AND BILL A TT
MODIFIER.
AS PER THIS NOTICE, PRIOR AUTHORIZATION REQUESTS FOR S9123 OR
S9124 WILL BE DENIED IS ANY MODIFIER OTHER THAN TT IS REQUESTED.
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