RA Messages for August 1, 2000
PHARMACY PROVIDERS, PLEASE NOTE!!!
IN A PROVIDER LETTER DATED JULY 19,2000, WE SUBMITTED CHANGES TO THE
FEDERAL UPPER LIMITS (FUL) WHICH WERE TO BECOME EFFECTIVE FOR DATES
OF SERVICE BEGINNING AUGUST 1, 2000. WE HAVE BEEN NOTIFIED BY THE HEALTH CARE FINANCE ADMINISTRATION TO DELAY IMPLEMENTATION OF THE AUGUST 1 FEDERAL UPPER LIMITS. THEREFORE, THE GENERIC DESCRIPTIONS
WITH THE AUGUST 1 PRICES WILL NOT BE IMPLEMENTED UNTIL THE DEPARTMENT
IS DIRECTED BY HCFA.
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 |
| ANAGRELIDE HCL |
CAP |
1MG |
|
06/14/00 |
| CAFFEINE CITRATED |
SOL |
20MG/ML |
|
06/01/00 |
| CLINDAMYCIN PHOS |
SUPP VAG |
100MG |
|
05/24/00 |
| ESTRADIOL |
TAB |
25MCG |
|
05/24/00 |
| ESTRADIOL/NORETH AC |
TAB |
1-0.5MG |
|
05/24/00 |
| FE/FUMARATE/FA/MV-MN/SE |
TAB |
|
|
06/01/00 |
| GEMTUZUMAB OZOGAMICIN |
VIAL |
5MG |
|
05/19/00 |
| INAMRINONE LACTATE |
AMP |
5MG/ML |
|
06/30/00 |
| PEMIROLAST POTASSIUM |
DROPS |
0.1% |
|
07/01/00 |
| PIMOZIDE |
TAB |
1MG |
|
06/01/00 |
| PORFIMER SODIUM |
VIAL |
75MG |
|
06/15/00 |
| SOMATROPIN |
KIT |
13.5MG;18MG;22.5MG |
|
06/28/00 |
| TESTOSTERONE |
GEL PACKET |
1%(25MG) |
|
05/08/00 |
| TESTOSTERONE |
GEL PACKET |
1%(50MG) |
|
05/08/00 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
.
NOTICE TO ALL OPTICAL SUPPLIERS
EFFECTIVE IMMEDIATELY, PA REQUESTS RELATED TO EYEGLASSES AND/OR CONTACT LENSES WILL BE GIVEN A 3-MONTH AUTHORIZATION PERIOD. THE PROVIDER SHOULD
INDICATE THE APPROPRIATE 3-MONTH SPAN IN THE DATES OF SERVICE BLOCKS ON THE REQUEST FOR PA FORM(PA01). THE BEGINNING DATE SHOULD BE THE DATE OF
INITIAL CONTACT WITH THE RECIPIENT. UPON APPROVAL, THE PROVIDER SHOULD DELIVER THE SERVICES AS SOON AS POSSIBLE WITHIN THE AUTHORIZED PERIOD.
IN ORDER FOR A CLAIM TO BE PAID BY MEDICAID FOR SERVICES THAT REQUIRE PA THE REQUEST MUST HAVE BEEN APPROVED AND DATES OF SERVICE MUST FALL
BETWEEN THE DATES LISTED ON THE PA DECISION. THE ACTUAL DATE THAT THE SERVICE WAS DELIVERED SHOULD BE USED AS THE DATE OF SERVICE WHEN FILING
A CLAIM FOR PAYMENT. SHOULD THE PA PERIOD EXPIRE BEFORE THE SERVICE IS DELIVERED, THE PROVIDER SHOULD MAKE A COPY OF THE PA LETTER AND WRITE RECON ACROSS THE TOP. A STATEMENT SHOULD ACCOMPANY THIS RECONSIDERATION REQUEST INDICATING THAT YOU ARE ASKING TO HAVE THE AUTHORIZATION DATES CHANGES AND THE REASON WHY THE SERVICE COULD NOT BE DELIVERED WITHIN THE
ORIGINAL AUTHORIZATION PERIOD. SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS MATTER, CONTACT UNISYS PROVIDER RELATIONS AT 1-800-473-2783.
NOTICE TO PROFESSIONAL PROVIDERS
EFFECTIVE WITH DATE OF SERVICE 07/01/00, ANESTHESIA FOR CPT CODE
92960, ELECTRICAL CARDIOVERSION, HAS BEEN FUNDED WITH AN ANESTHESIA BASE UNIT OF
04.
NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES
THE CPT CODES WHICH WERE DISCONTINUED IN THE YEAR 2000 ISSUANCE
OF THE CURRENT PROCEDURAL TERMINOLOGY WILL BE PLACED IN NON-PAY STATUS ON OUR
FILES EFFECTIVE WITH DATE OF SERVICE AUGUST 15, 2000. PLEASE PROGRAM YOUR
SYSTEMS ACCORDINGLY.
NOTICE TO ALL DENTAL PROVIDERS
PERSONS UNDER 21 YEARS OF AGE WHO ARE CERTIFIED FOR MEDICAID
UNDER THE MEDICALLY NEEDY PROGRAM ARE NOW ENTITLED TO RECEIVE MEDICAID COVERED
EPSDT DENTAL SERVICES. THE MEDICALLY NEEDY RECIPIENT WILL HAVE A MEDICAID
CARD AND THE PROVIDER SHOULD FOLLOW CURRENT POLICIES AND PROCEDURES, AS
STATED IN THE MEDICAID DENTAL SERVICES MANUAL, WHEN PROVIDING SERVICES TO THESE
RECIPIENTS. PROVIDERS SHOULD VERIFY THE RECIPIENT'S ELIGIBILITY USING THE
RECIPIENT VERIFICATION SYSTEM (REVS) OR THE MEDICAID ELIGIBILITY VERIFICATION
SYSTEM (MEVS). FOR MORE INFORMATION REGARDING THE MEDICALLY NEEDY PROGRAM,
PLEASE REFER TO YOUR DENTAL SERVICES MANUAL, PAGES 1-7 THROUGH 1-8. SHOULD
YOU HAVE ANY FURTHER QUESTIONS REGARDING THIS MATTER, YOU MAY CONTACT UNISYS
PROVIDER RELATIONS BY CALLING 1-800-473-2783.