DOH Medicaid Update April 2000 Vol.15, No.4

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Providers who need replacement copies of their remittance statements should send their requests in writing to:

Computer Sciences Corporation
Attention: Remittance Retrieval
800 North Pearl Street
Albany, NY 12204

The following information must be included in the request:

• Provider ID number
• Provider address and telephone number
• Remittance statement number (if known)
• MMIS check date (if there is a check associated with the remittance)

If the remittance number is unknown and there is no associated check, indicate the week (Monday date) on which the remittance was issued.

Please Note:

• There will be a charge of 25 cents per page. (Providers should not send any payment with their request.)
• CSC will notify the provider, in writing, of the number of pages and the total cost.
• The remittance statement will be mailed to the provider upon receipt of check or money order for the appropriate amount.

Providers making inquiries or requesting billing training by Regional Representatives should contact Computer Sciences Corporation (CSC) by calling the appropriate number below. Please be prepared to supply your Medicaid Provider ID number.

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The New York State Medicaid program is pleased to announce the availability of EMEVS eligibility PC software and free telecommunication access to the EMEVS. The State will waive the one time PC alternate access fee (PC communication set-up and testing fee) previously required.

New York State Medicaid providers may obtain eligibility and service authorizations from the EMEVS by using their personal computers. PC-Host software is available through the EMEVS contractor, eFunds Corporation (formerly known as Deluxe Electronic Payment Systems (DEPS)). This software does not meet the needs of the pharmacy community and, therefore, will not be made available to pharmacies.

The software comes on easy to install diskettes along with a detailed user guide to assist in the installation of the software. The guide also gives examples of the input and response screens. For providers with special in-house applications, the import and export file specifications are included for setting up files that can be used with the software. The advantages of using the PC-Host software over the Tranz 330 card swipe terminal or the touch-tone phone (Audio Response System) is the ease of use and the speed of the transaction.

Features of the PC software include Windows based application, dial-up (modem) on-line real-time access, eligibility inquiries, service authorizations, authorization confirmations, authorization cancels, dispensing validation system transactions, easy to read input screens with pull down windows and on-line help. Providers also have the option of sending a single transaction, an entire file or importing a file from provider specific applications.

Any providers requesting free PC access (including DME Dispensing Validation providers) that currently accesses EMEVS via a State owned Tranz 330 swipe terminal will be asked to return the terminal once it begins successfully sending PC transactions.

The PC-Host EMEVS eligibility software is available through eFunds Inc., Government Services Division. If you would like additional information or are interested in obtaining a copy of the software, please call the EMEVS Provider Relations Help Desk at 1-800-343-9000.

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The New York State Medicaid program will no longer provide Tranz 330 Verifone terminals free of charge. A provider who currently has a State-owned Tranz 330 terminal and uses the terminal in accordance with State policy (an average of 200 Tranz 330 terminal transactions over a three-month period) and does not want PC EMEVS access can continue using the terminal. Maintenance of all currently deployed State owned terminals will continue to be the responsibility of the State. The exception to this policy involves DME Dispensing Validation providers and providers identified as mandatory swiping providers.

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The billing code for the enteral product EleCare has been changed. Use code B4153 effective immediately. Claims received after August 1, 2000 for this product under code B4154 will be denied.

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In support of Governor Pataki's and Commissioner Novello's smoking cessation initiative, the Medicaid program provides reimbursement for prescription and non-prescription smoking cessation agents. Medicaid coverage is limited to two courses of treatment per recipient per year. A course of treatment is defined as no more than a 90-day supply (an original prescription and two refills).

Success in smoking cessation treatment may require additional behavioral supports. The following list of cost-free programs may be helpful referral sites for your patients who are ready to quit smoking. (List reprinted from the December 1999 Medicaid Update.)

Additional Supports from manufacturers

Glaxo Wellcome - Zyban

• Support package includes: a Patient's Program Guide, Plan to Succeed Workbook, Enrollment Questionnaire and envelope.
• Toll-free enrollment number: 1-800-UCAN-QUIT (1-800-822-6784)

McNeil Consumer - Nicotrol Nasal Spray, Nicotrol Inhaler

• Support Package includes: Pathways to Change Booklet and a Personal Quit Guide
• Toll-free number: 1-888-NICOTROL (1-888-642-6876)

Other Resources

Local cessation support program information can be obtained from:

American Cancer Society

• Toll-free number: 1-800-ACS-2345 (1-800-232-1311)

American Lung Association

• Toll-free number: 1-800-586-4872

BROCHURES AND OTHER INFORMATION

Centers for Disease Control and Prevention

• Toll-free number: 1-800-CDC-1311 (1-800-232-1311)

National Cancer Institute

• Toll-free number: 1-800-4-CANCER (1-800-422-6237)

U.S. Food and Drug Administration

• Toll-free number: 1-888-FDA-4KIDS (1-888-332-4543)

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

Effective Date	Drug	Dosage	NDC#
February 1, 2000	Synagis	Inj 50 mg	60574-4112-01

Claims for this drug 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 these claims no later than 12:00 noon on August 1, 2000. Questions regarding submission of pharmacy claims may be addressed to CSC at 1-800-522-5535.

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Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid Management Information System (MMIS), announces the following schedule of Introductory Seminars. Topics will include:

• Overview of MMIS
• Explanation of MMIS Provider Manual
• Discussion of Medicaid Managed Care
• Overview of Billing Options
• Explanation of 90-day Regulation
• Explanation of Utilization Threshold Program

Please indicate the seminar(s) you wish to attend below:

May 31 [_______] 10 AM
The Galleries
Curtain Auditorium (enter through Public Library)
447 South Salina Street
Syracuse, NY

June 27 [_______] 10 AM or [_______] 2 PM
New York City, NY
(address to be announced - see below)

August 23 [_______] 10 AM
Westchester County Department of Social Services
85 Court Street
White Plains, NY

September 27 [_______] 10 AM
Suffolk County Department of Social Services
3085 Veterans Memorial Highway
Ronkonkoma, NY

Other seminars may be scheduled as new programs are implemented or changes to existing billing procedures are announced.

Please complete the following registration information:

Provider Name:__________________________________Provider ID:__________________
Provider Category of Service:________________________________Number Attending:__________
Contact Name:____________________________________Phone Number:______________________

If the seminar address is not listed above, a CSC representative will contact you at least two weeks prior to the seminar date to confirm attendance and provide seminar address information. Each seminar will last approximately two hours. Providers who have questions about these seminars can call CSC at the following numbers:

To register, please mail this completed page to:

Computer Sciences Corporation
Attn.: Provider Outreach
800 North Pearl Street
Albany, NY 12204

Or, you may fax a copy of the completed page to: 518-447-9240

Note: Please keep a copy of your seminar choice for your records. No written confirmations will be sent.

Thank you for participating in New York State's Medicaid program.

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Effective April 1, 2000, the New York State Medicaid program recognized some additional procedures to accommodate the expanded scope of practice of optometrists, as set forth in Section 7101 of the State Education Law. Optometrists must practice both within their scope of practice and within their competency, as required by Section 6509 of the Education Law and Part 29 of the Rules of the Board of Regents. The additional billable procedures for optometrists are as follows:

CODE	DESCRIPTION	FEE
67820	Correction of trichiasis; epilation,by forceps only (requires Prior Approval)	$16.00 (15 follow-up days)*
68761	Closure of lacrimal punctum; by plug, each	$16.00 (15 follow-up days)*
68801	Dilation of lacrimal punctum,with or without irrigation	$ 8.00
68810	Probing of nasolacrimal duct,with or without irrigation	$12.00
68840	Probing of lacrimal canaliculi,with or without irrigation	$ 8.00
92100	Serial tonometry (separate procedure)with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure)	$ 4.00
92130	Tonography with water provocation	$16.00
92270	Electro-oculography with interpretation and report	$25.00
92275	Electroretinography with interpretation and report	$35.00
95930	Visual evoked potential (VEP) testing central nervous system, checkerboard or flash	$90.00
99242	Office consultation for a new or established patient, which requires these three key components: an expanded problem focused history, an expanded problem focused examination, and straightforward medical decision-making	$24.00
99243	Office consultation for a new or established patient, which requires these three key components: a detailed history, a detailed examination, and medical decision-making of low complexity	$24.00
99244	Office consultation for a new or established patient, which requires these three components: a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity	$24.00

*Follow-up days: Listed dollar values for all surgical procedures include the surgery and the follow-up care for the period indicated.
Questions concerning the above should be directed to the Office Of Medicaid Management, Bureau of Policy Development and Agency Relations, at (518) 473-5953.
Optometric procedure codes implemented in August 1998 and August 1999 can be found in the DOH Medicaid Updates, June 1998 Vol. 13, and July 1999 Vol. 14 respectively.

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By law, Medicaid is always the payor of last resort. If a recipient is also enrolled in a Commercial or Medicare HMO and the provider does not participate in that HMO, the provider should refer the recipient to a participating provider of that plan for covered services when appropriate. If the recipient is enrolled in a Medicaid HMO and the provider does not participate in the HMO, the Medicaid provider should refer the recipient to the HMO or the recipient's PCP for covered services.

In all instances, a referral to the HMO is not necessary if it is an emergency, or the recipient has obtained a referral from the HMO to see the provider, or the service needed is not in the benefit package of the health plan.

Should you have any questions, please contact Barbara Pukis at (518) 473-5604.

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Please note the following new item codes, effective for dates of service on or after May 1, 2000. BOLD code numbers indicate that prior approval is required. When the description is preceded by a "#", Electronic Medicaid Eligibility Verification System (EMEVS) dispensing validation is required. A copy of this article should be placed in your DME Provider Manual (Rev. 4/99).

CODE	PRODUCT	PRICE
E0144	Enclosed, framed folding walker, wheeled, with posterior seat Provides safety and promotes unassisted walking, may include brake and/or variable resistance wheels. For an adult or child who requires enclosure and seat due to motor and balance dysfunction.	$363.92
Z3955	#Posterior folding walker, wheeled, adjustable (posture control walker) Provides support and encourages upright positioning for walking. For an adult or child who requires gait training/retraining due to mild to moderate motor and balance dysfunction.	$231.40
Z3956	Walker/trainer, wheeled, adjustable height, with trunk support. Provides complete adjustment of trunk angle and support, forearm, leg and/or pelvic prompts, stimulates walking movements, and includes variable resistance brakes/wheels. For an adult or child who requires gait training/retraining due to moderate to severe motor and balance dysfunction.	$709.20
Z3957	Walker/trainer, wheeled, with seat, adjustable height, with full postural, lateral and/or prone support. Provides complete adjustment of center of gravity, trunk angle and support, forearm, leg and/or pelvic prompts, stimulates walking movements, and includes locking casters and/or brakes. For an adult or child who requires gait training/retraining due to severe motor and balance dysfunction.	$1262.82
Z4725	Bath or shower chair, positioning, with or without commode feature, mobile or stationary Provides support and safety while bathing or showering for an adult or child in need of varying levels of assistance in self-care. Utilizes recline, adjustable and/or positioning features and may include full upper and lower extremity support.	$380.25

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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