DOH Medicaid Update February 2000 Vol.15, No.2

---

The provider enrollment seminar that was required as part of the enrollment process in the New York State Medicaid Program for practitioners in the New York City area has been suspended. A booklet entitled "Introduction to the New York State Medicaid Program" will be sent to applicants and will contain material that would have been covered at the seminar. Practitioners enrolling in the program will be required to read this booklet and sign an attestation form to be returned to the Department certifying that they have read the material and will comply with the rules and regulations of the Medicaid Program. Once the Department receives the signed attestation forms, applications will be processed.

After April 1, 2000, the booklet will become part of the Medicaid enrollment application statewide for physicians, registered physician's assistants, podiatrists, nurse practitioners and nurse midwifes.

Effective July 1, 2000, all enrollments for the categories mentioned above must be submitted using the new application. If an application is received after July 1, 2000, with a version of the application dated prior to April 1, 2000, it will be returned with a copy of the new application. This will cause a delay in the application process.

To obtain copies of the new application forms, please call the Bureau of Enrollment at:

(518) 486-9440 or write to:

New York State Department of Health
Office of Medicaid Management
Bureau of Provider Enrollment
99 Washington Avenue - Suite 611
Albany, New York 12210-2806

---

The Provider Outreach Staff at Computer Sciences Corporation (CSC) contributes the CSC Billing Bulletin to the Medicaid Update in order to give providers reminders and helpful hints about a variety of Medicaid billing topics. If you have suggestions for topics or have billing questions you would like to see addressed in future CSC Billing Bulletin articles, please send your suggestions to the following address: Computer Sciences Corporation

Attn.: Provider Outreach
North Pearl Street
Albany, NY 12204

Or, you may fax your suggestions to: Provider Outreach (518) 447-9240

Please Note: Suggested topics and billing questions will be addressed in future CSC Billing Bulletin articles. Questions regarding policy, enrollment or Electronic Medicaid Eligibility Verification System (EMEVS) issues should be directed to the appropriate phone numbers or addresses in the inquiry section of the New York State Medicaid Management Information System Provider Manual.

Topics of previous CSC Billing Bulletin articles in the Medicaid Update are listed in the table below:

CSC Billing Bulletin Topics	Date	Page
90-day Submission Reminders	November 1997	2
Adjustment/Voids	March 1998	6
Billing Questions/Training - Regional Representative and Inquiry Unit Availability	September 1997	1
Claim Correction Forms	October 1998	8
Computerizing Medicaid Billing	January 1998	1
CSC Inquiry Unit Phone Numbers	December 1999	4
Edit Review Panel (Edits 00127, 00262, 01281 and 01283)	February 1999	3
Managed Care Related Remittance Statement Messages (Edits 01172 and 01173)	November 1999	4
Other Insurance Reminders	May 1998	3
Physician Specialty Codes (Edits 00297, 00299, 00135 and 01154)	August 1997	6
Place of Service Codes	November 1998	6
Prior Approval Purge Criteria	December 1997	1
Provider Manual Updates	July 1997	2
Staff Available for Seminars/Associations	December 1998	4
Timing Is Everything	October 1999	3
Transportation -Edit 00244 - PA Not On File	August 1998	6
Utilization Threshold (UT) - Common Questions, Edit 01154 Pends/Denials	April 1997	3
Utilization Threshold (UT) - Reminders	March 1997	1-2
Valid Attachments	June 1999	1

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

---

To support New York State's continuing anti-tobacco initiative, various Department of Health (DOH) educational materials are available to encourage smoking prevention and treatment. Materials include "no smoking" signs; fact sheets from the Centers for Disease Control and Prevention; a reproducible "fortune teller" of tobacco facts for teens and more!

Other DOH publications are also available, including the new "Just Tell the Truth" poster and bookmark; "Protecting Our Children: New York's Adolescent Tobacco Use Prevention Act"; "101 Reasons Not to Smoke" and boy and girl anti-smoking brochures.

To obtain these materials, please contact:

Bureau of Community Relations
New York State Department of Health
Corning Tower, Room 1748
Empire State Plaza
Albany, NY 12237

Reminder: As a commitment to provide assistance to Medicaid recipients who want to stop smoking, Medicaid now covers prescription and non-prescription smoking cessation agents. We appreciate your participation in making New Yorkers healthier.

---

Please be advised that an edit has been added to the Dispensing Validation System (DVS) used for processing Viagra claims. As of December 4, 1999 any Viagra claim with a days supply of less than 30 will be rejected for the new DVS denial code 720, "Days supply less than minimum required".

CLARIFICATION OF VIAGRA POLICY

• Maximum quantity of Viagra every 30 days is SIX tablets.
• ANY QUANTITY of Viagra tablets dispensed, up to and including six tablets, is considered to be a 30 day supply.
• DO NOT fill or refill prescriptions for Viagra before the 31^st day as the DUR system will reject them as Therapeutic Duplications. Do NOT override. Claims filled prior to the 31^st day have been and will be denied payment. If claims are captured, Medicaid will recoup reimbursement for those claims inappropriately paid.
• Medicaid will reimburse for only one strength of Viagra per recipient per month. Changes in dosage strength prior to the 31^st day are NOT permitted.

---

Please keep this information in Section 4.2 of your MMIS Provider Manual under "Enteral Therapy".

The following list of enteral formulae is provided as a guideline for dispensers when the prescriber has ordered an enteral formula using the brand name. This list is not an all-inclusive list, but is meant to assist providers in determining the correct item code for use in MMIS billing. For products not listed below, providers are to use their judgment in selecting the appropriate product classification based upon the physician's order and the general categorical descriptions. If the product ordered does not fall under one of the seven categories listed below, providers may use the "Not otherwise classified" code B9998, which requires prior approval.

The calculation for pricing Enteral Therapy is as follows: Number of calories per can divided by 100 = number of caloric units per can. Medicaid will pay for up to 600 caloric units per item code per month.

The Maximum Reimbursable Amount per caloric unit that may be billed to Medicaid is noted for each category. Formulae categories that are reimbursed By Report require an invoice attached to the claim to document the acquisition cost.

Each claim for B4150-B4156, Z2111, and Z2112 requires a Dispensing Validation number (DVS).

#Category I - SEMI-SYNTHETIC INTACT PROTEIN ITEM CODE B4150 MRA 0.5315/ONE CALORIC UNIT
Attain	Fiberlan	Lonalac Powder	ProBalance
Bio-care (powder)	Fibersource	Meritene Liquid	Profiber Liquid
Boost	Fibersource HN	Meritene Powder	Promote
Boost High Protein Liquid	Forta Drink Powder	Nitrolan	Propac Powder
Boost High Protein Powder	Forta Shake Powder	NuBasics 2.0	Resource
Boost Pudding	Glytrol	NuBasics Juice Drink	Resource for Kids w/Fiber
Boost w/Fiber	Isocal	NuBasics VHP	Resource Diabetic
Citrisource	Isocal HN Plus	Nutramigen	Resource for Kids
Enlive	Isocal HN	Nutren 1	Resource Fruit Bev.
Ensure	Isolan	Nutrilan	Sustacal
Ensure High Protein	Isomil	Osmolite	Sustacal Powder (Basic)
Ensure HN	Isosource	Osmolite HN	Sustacal Pudding
Ensure Light	Isosource HN	Osmolite HN Plus	Sustacal w/Fiber
Ensure Powder	Jevity	Pediasure	Sustagen Powder
Ensure Pudding	Jevity Plus	Pediasure w/ Fiber	Ultracal
Ensure w/ Fiber	Kindercal	Portagen Powder	Ultracal HN Plus

#Category I - NATURAL INTACT PROTEIN/PROTEIN ISOLATES ITEM CODE B4151 MRA 1.3245/ONE CALORIC UNIT
Compleat Modified	ProSobee
Compleat-B	Vitaneed

#Category II - INTACT PROTEIN/PROTEIN ISOLATES (CALORICALLY DENSE) ITEM CODE B4152 MRA 0.4046/ONE CALORIC UNIT
Boost Plus	Isosource 1.5	NutrAssist 1.5	Scandi Shake(pow)
Comply	Magnacal	Nutren 1.5	Sustacal Plus
Deliver 2.0	Magnacal Renal	Nutren 2.0	TwoCal HN
Ensure Plus	NovaSource 2.0	Resource Plus	Ultralan
Ensure Plus HN	NuBasics Plus	Respalor

#Category III - HYDROLIZED PROTEIN/AMINO ACIDS ITEM CODE B4153 MRA 2.0271/ONE CALORIC UNIT
Criticair HN	Neocate	Peptamen 1.5 Diet	Vital HN
Glutasorb RTU	Neocate One + Liquid	Peptical	Vivonex Pediatric
Isotein HN Powder	Neocate One + Powder	Reabilan
L-Emental	NutriVir	Subdue
L-Emental Pediatric	Optimental	Travasorb HN

#Category IV - DEFINED FORMULAE FOR SPECIAL METABOLIC NEED ITEM CODE B4154 PRICED BY REPORT/ONE CALORIC UNIT
80056	Impact	OS 2	ReGain Plus
Acerflex	Isosource VHN	Peptamen	Renalcal
Advera	L-Emental Hepatic	Peptamen Jr	Re-Neph
Alimentum	Lipisorb Liquid	Peptamen VHP	Re-Neph Free
Alitraq Powder	Lipisorb Powder	Perative	Replete
Amin Aid Powder	Lofenelac Powder	Periflex (powder)	Resource Select
Analog Formulas	Lorenzo Oil	Phenex 1	SandosourcePeptid
Choice DM	Maxamaid (powder)	Phenex 2	Stresstein Powder
Citrotein Powder	Maxamum(powder)	PhenyAde Powder	Suplena(Replena)
Cyclinex-1	MSUD Diet Powder	Phenylfree Powder	Traumacal
Cyclinex-2	MSUD Maxamum	PKU2	Traum-Aid HBC
Diabetisource	MSUD-1 Powder	Pregestimal	Travasorb Hepatic
Duocal	MSUD-2 Powder	Product 80056	Travasorb -MCT
EleCare Powder	Nepro	Pro-Peptide	Travasorb Renal
Elemental 028 Extra	NovaSource Pulmonary	Pro-Peptide VHN	Vivonex Plus
Glucerna	Novasource Renal	Propimex 1 (powder)	Vivonex TEN
Glucerna OS	Nutrihep	Propimex 2 (powder)	XMET Maxamaid
Hepatic-Aid Powder	NutriVent	Pulmocare	XMET Maxamum
Immun-Aid	OS 1	Reabilan-HN	XP Maximum

#Category V - MODULAR COMPONENTS ITEM CODE B4155 PRICED BY REPORT/ONE CALORIC UNIT
Casec Powder	HPF Plus	Moducal Powder	Product 3232A
Egg/Pro Powder	Immunocal	Phlexy-10 Capsules	ProMod Powder
Essential Pro Plus	Juven	Phlexy-10 Drink Mix	ReSource Inst Protein Pow
Essential Protein	Lipomul	Polycose Liquid	Ross Carbohydrate Free
Gevral Protein Pow	MCT Oil	Polycose Powder	SoyPro
Hom 2	Microlipid	ProCel Powder	Sumacal

#Category VI - STANDARDIZED NUTRIENTS ITEM CODE B4156 MRA 1.2389/ONE CALORIC UNIT
Tolerex Powder	Vivonex Standard
Travasorb Standard

Not otherwise classified - REQUIRES PRIOR APPROVAL ITEM CODE B9998 PRICED BY REPORT
Apple Fiber	LactAid tablets	Sorbitol 70%
Flavonex	NeoCalglucon	Vivonex flavor pkts

ALL OTHER NOT OTHERWISE CLASSIFIED
Z2111 #Food Thickener Reg per oz
Z2112 #Food Thickener Con per oz

---

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