DOH Medicaid Update March 1999 Vol.14, No.3

---

Newly issued Medicaid benefit cards have had additional numbers added to the face of the card. The ISO number, access number, and sequence number from the bottom right corner of the card are repeated in succession on the top line following the client identification number (CIN). This change does not affect the recipient's eligibility, and should not cause a provider to question the validity of the card.

Recipients were informed of this change in language added to the card carrier (the insert that holds the benefit card when it is mailed statewide, or, when it is picked up at one of the two over-the-counter sites in NYC). The message says, "Additional numbers have been added to the benefit card. This change does not affect your eligibility. If your Medicaid provider has any questions, show them this paper."

Verification of the recipient's eligibility through the Electronic Medicaid Eligibility Verification System (EMEVS) should provide you with the information needed to provide services.

If you continue to have concerns about the validity of the card, those questions may be directed to the local social services district office where the recipient applied for Medicaid coverage.

---

This is to inform providers of a recent technical change in Social Services Law regarding certain qualified aliens. A qualified alien who has continuously resided in the United States since prior to August 22, 1996, regardless of when he or she obtained the status of qualified alien, is eligible for Family Assistance, Medicaid and Safety Net Assistance. Previously, the law required that the alien must have been a lawful resident of the United States prior to August 22, 1996 in order to receive Medicaid for other than emergency medical treatment, or Family Assistance.

Current qualified aliens will be required to verify continuous residence in the United States since before August 22, 1996 in order to receive all Medicaid services if otherwise eligible.

---

These instructions apply only to those providers who are named plaintiffs in the above-cited action.

This article will:

• remind providers that the submission of edit corrections ended with the December 1998 purge run - except as noted in the following;
• remind providers that the March 1999 purge cycle was the final error correction opportunity afforded to providers with previous Edit 162 and Edit 140 failures; and
• remind providers that they may still submit documentation to permit adjudication of claims pended for Edits 127, 262 or 1281.

_________________________________________________________

1. The Department has previously informed you that the opportunity for submission of edit corrections of lawsuit claims ended with the last scheduled purge run for calendar year 1998.
2. The Department has also previously informed you of a special process used as a final effort to resolve Edit 140 and Edit 162 claims. Providers who had claims that had failed either Edit 140 or Edit 162, and after special processing had failed some other edit, had also been advised of the one additional opportunity to correct these edit failures. That opportunity ended with the March 1999 purge cycle.
3. Providers may still continue to send in the required documentation to confirm Medicare data for any claim that pended for Edits 127, 262 or 1281, but only until May 11, 1999. The June 1999 purge cycle will be the final Medicare lawsuit claims processing cycle.

Providers responding to any of these three edits should send in a copy of the appropriate Provider Remittance Statement along with a copy of the applicable Explanation of Medicare Benefits [EOMB] to:

PLEASE NOTE: Documentation that is submitted is required to be clipped together and properly highlighted, to permit accurate review. Failure to properly follow these instructions may result in non-payment if reviewers are unable to match documentation to specific claims.

For assistance, please call your CSC Healthcare Systems representative at:

Practitioner services: 1-800-522-5518 or (518) 447-9860
Institutional services: 1-800-522-1892 or (518) 447-9810
Professional services: 1-800-522-5535 or (518) 447-9830

---

The following drugs have been added to the list of drugs that are not included within the drug cost components of Article 28 Nursing Facility Rates:

Effective Date	Drug	NBC#
August 28, 1998	Risperdal Sol 1 mg/ml	50458-0305-03
December 30, 1998	Ziagen Sol 20 mg/ml	00173-0664-00
December 30, 1998	Ziagen Tab 300 mg	00173-0661-01

Claims for these drugs that are submitted more than 90 days from the dispensing date must be submitted with a copy of this article. Computer Sciences Corporation (CSC) must receive claims no later than 12:00 noon on June 1, 1999. Questions regarding submission of pharmacy claims may be addressed to CSC at 1-800-522-5335.

---

The State Department of Health welcomes your comments or suggestions regarding the Medicaid Update.

Please send suggestions to the editor, Timothy Perry-Coon:

NYS Department of Health
Office of Medicaid Management
Bureau of Program Guidance
99 Washington Ave., Suite 720
Albany, NY 12210
(e-mail MedicaidUpdate@health.state.ny.us )

The Medicaid Update, along with past issues of the Medicaid Update, can be accessed online at the New York State Department of Health web site: http://www.health.state.ny.us/health_care/medicaid/program/main.htm