RA Messages for September 28, 1999
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 8/15/98 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| BUTOCONAZOLE NITRATE |
CRM/PF APP |
20% |
|
10/01/99 |
| CALFACTANT |
VIAL |
35MG/ML |
|
08/24/99 |
| FLUOXETINE HCL |
CAPSULE |
40MG |
|
09/19/99 |
| IVERMECTON |
TABLET |
3MG |
|
09/01/99 |
| KETOTIFEN FUMARATE |
DROPS |
0.025% |
|
09/15/99 |
| LIDOCAINE |
ADH
PATCH |
5% |
|
09/15/99 |
| LIDOCAINE HCL |
CREAM |
3% |
|
08/23/99 |
| ONDANSETRON HCL |
TABLET |
24MG |
|
09/20/99 |
| PIOGLITAZONE HCL |
TABLET |
15MG;30MG;45MG |
|
10/01/99 |
| SOMATROPIN |
CARTRIDGE |
18U;72U |
|
08/23/99 |
| TEMOZOLOMIDE |
CAPSULE |
5MG;20MG;100MG;250MG |
|
08/17/99 |
| ZALEPLON |
CAPSULE
|
5MG;10MG
|
|
08/20/99 |
| ZANAMIVIR |
DISK W/DEV |
5MG |
|
09/15/99 |
PLEASE MAKE THE FOLLOWING CHANGES TO THE
8/15/98 VERSION OF APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 11845 |
MASON DISTRIBUTORS, INCORPORATED |
|
10/01/99 |
| 64764 |
TAKEDA
PHARMACEUTICALS AMERICA |
10/01/99 |
|
| 64909 |
ZOETICA
PHARMACEUTICAL CORPORTAION |
10/01/99 |
|
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN
INCORRECTLY PAID
PHARMACY PROVIDERS
POS CLAIMS SUBMITTED WITH THE 16 DIGIT CARD HOLDER NUMBER (CCN)
AND A '2' IN THE 'ELIGIBILITY
OVERRIDE CLARIFICATION CODE' FIELD WILL DENY WITH
EDIT 215.
PHARMACISTS AND PHYSICIANS
NOTE: MEDICARE REQUIRES PHYSICIANS TO PROVIDE ICD-9
DIAGNOSIS CODES ON ALL CERTIFICATES
OF MEDICAL NECESSITY. ONLY ICD-9 CODES ARE ACCEPTABLE. THERE IS NO
PROVISION FOR NARRATIVE DIAGNOSIS. THEREFORE, EFFECTIVE FOR DATES OF SERVICE
10/01/99, LOUISIANA MEDICAID WILL ONLY ACCEPT ICD-9 DIAGNOSIS
CODES TO BE CONSISTENT WITH MEDICARE POLICY. ANY ORIGINAL PRESCRIPTION
BILLED PRIOR TO 10/01/99 WITH REFILLS REMAINING WILL HAVE PAYMENTS
FOR THOSE REFILLS GRANDFATHERED IF THE NARRATIVE DIAGNOSIS IS PRESENT
ON THE PRESCRIPTION HARD-COPY OR THE ATTACHMENT. HOWEVER,AFTER THE
AUTHORIZED REFILLS HAVE BEEN EXHAUSTED, ONLY ICD-9 DIAGNOSIS CODES WILL BE THE
ACCEPTABLE FORM OF DOCUMENTATION. ANY QUESTIONS CONCERNING THIS CHANGE CAN BE
DIRECTED TO THE POS HELP DESK AT 1-800-648-0790 OR (225) 237-3381.