DOH Medicaid Update March 2000 Vol.15, No.3

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The following drugs have 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#
October 26, 1999	Rescriptor	Tab 200 mg	00009-7576-01
December 6, 1999	Zyprexa	Tab 15 mg	00002-4415-30

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 these claims no later than 12:00 noon on July 3, 2000. Questions regarding submission of pharmacy claims may be addressed to CSC at 1-800-522-5535.

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The Health Care Financing Administration (HCFA) recently established a national limitation amount (NLA) for Medicare and Medicaid payments for the HIV-1 viral load test. The current reimbursed fee is $128.58. Based on cost and payment data, HCFA has established a Medicaid NLA of $117.59 for the HIV-1 viral load test (Medicaid CPT code Y8706). When billing Medicaid for the HIV-1 viral load test for dates of service on or after May 1, 2000 you will be reimbursed at $117.59, or your usual and customary charge to the general public, whichever is lower.

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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 10, 10 AM
Poughkeepsie, NY (address to be announced - see below))

May 23, 10 AM
Computer Sciences Corporation
800 North Pearl Street, Third Floor
Menands, NY

May 25, 10 AM
The Galleries
Curtain Auditorium (enter through Public Library)
447 South Salina Street
Syracuse, NY

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

July 19, 10 AM
Nassau County Department of Social Services
101 County Seat Drive
Mineola, 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:

Practitioner Services     (800) 522-5518  (518) 447-9860
Institutional Services     (800) 522-1892  (518) 447-9810
Professional Services     (800) 522-5535  (518) 447-9830

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.

 

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The Office of Medicaid Management is announcing the implementation of a front end EMEVS prescriber license verification edit. Beginning in late Spring, an edit will be activated to verify that a prescriber or orderer license or MMIS ID number reported on EMEVS transactions is accurate and legitimate. This edit will be applied to all transactions that require the entry of a prescriber or orderer ID number. The edit will help protect providers against fraudulent orders and prescriptions written by sanctioned providers, without the need to check paper lists. The prescriber ID field on the EMEVS transaction will be matched against the State Education Department's (SED) license file and the Department of Health's (DOH) MMIS ID number file. Any transaction failing the match will be rejected, allowing the submitting provider an opportunity to correct the problem before resubmitting a claim. There has been a similar, back end edit, in place for a number of years. However that edit was not activated for pharmacy claims.

In order to give pharmacies an opportunity to purge their computer files of incorrect licenses or MMIS ID numbers, prior to activating the front end edit, the DOH will test reported license and MMIS numbers against a cycle of paid pharmacy claims. During April, the DOH will send each pharmacy its listing of prescriber license numbers and MMIS numbers that would have failed the new edit. The pharmacies will also be given a prescription number as reference for each failed license/MMIS number. This information will allow the pharmacies to identify and contact the prescriber to obtain their correct number. As an alternative, pharmacies can also contact SED on line at http://www.nysed.gov/dpls/opnme.html to obtain or verify license numbers.

Pharmacists are also urged to consult the NYS ProDUR/ECC User Manual - Table 2 Error Chart (page 52) for instructions on completing the prescriber ID field. The instructions describe the proper completion of NCPDP field 411 that identifies the prescriber number and prescriber type, and shows examples of how these must be entered. This field will be reviewed and edited for accuracy. Listed below is a chart identifying all prescriber types currently in use by the DOH.

Remember, when the MMIS identification number is used, be certain to leave the license type code field blank.

Medicaid enrolled physicians are reminded that they need to provide pharmacies with their MMIS ID number or SED license number when requested in the course of filling their patients' prescriptions.

Prescriber Type	Type Code
Physician (MD or DO)	01
Dentist	02
Physician Assistant	09
Out of State Physician (MD or DO)	11
Out of State Dentist	12
Out of State Physician Assistant	19
Optometrist	25
Podiatrist	26
Audiologist	27
Nurse Practitioner	29
Midwife	29
Out of State Optometrist	35
Out of State Podiatrist	36
Out of State Audiologist	37
Out of State Nurse Practitioner	39
Out of State Midwife	39

If you have any questions, you can contact Sal Medak, Bureau of Performance Assessment and Reporting, at (518) 474-2239.

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The Department of Health has made a commitment to provide assistance to Medicaid recipients who want to stop smoking. Medicaid provides reimbursement for prescription and non-prescription smoking cessation drugs. The use of smoking cessation products in conjunction with as little as three minutes of counseling can significantly increase the smoking cessation success rate.

Counseling supports available to Medicaid recipients include a toll-free smoking help-line staffed by employees of the Roswell Park Cancer Institute.

Smoking cessation directories, local referrals and educational materials may be available by contacting the Regional Tobacco Control Coalitions listed below.

Adirondack Tobacco Free Network Saratoga, NY Counties Served: Warren, Washington, Clinton, Franklin, Essex, Saratoga 518-581-1230	Healthy Living Partnership Cortland, NY Counties Served: Tompkins, Cortland, Cayuga, Madison 607-756-3416	Rural Three for Tobacco Free Communities Cooperstown, NY Counties Served: Delaware, Otsego, Schoharie 607-547-6045 ext. 243
Broome & Tioga Tobacco Free Coalition Binghamton, NY Counties Served: Broome, Tioga 607-778-2802	Livingston County Tobacco Control Coalition Mt. Morris, NY Counties Served: Livingston 716-243-7524	Smoke Free Dutchess Poughkeepsie, NY Counties Served: Dutchess 914-471-0194
Capital District Tobacco-Free Coalition Albany, NY Counties Served: Albany, Rensselaer, Schenectady 518-459-4197 ext. 322	Mohawk Valley Coalition for Tobacco Concerns Mohawk, NY Counties Served: Oneida, Herkimer 315-866-1004	Smoke-Free Genesee/Orleans/ Wyoming Batavia, NY Counties Served: Genesee, Orleans, Wyoming 716-343-9620 ext. 135
Chautauqua-Cattaraugus Tobacco Free Initiative Mayville, NY Counties Served: Chautauqua, Cattaraugus 716-753-4795	Monroe County Smoking & Health Action Coalition Rochester, NY Counties Served: Monroe 716-442-4260	Southern Tier Tobacco Awareness Coalition Elmira, NY Counties Served: Chemung, Schuyler, Steuben 607-737-2028
Chenango Tobacco Coalition Norwich, NY Counties Served: Chenango 607-334-7144	Nassau-Suffolk Tobacco Control Task Force Hauppauge, NY Counties Served: Nassau, Suffolk 516-853-3144	Sullivan County Tobacco Task Force Liberty, NY Counties Served: Sullivan 914-292-0100 ext. 2731
Communities for a Smoke-Free Living Project New York, NY Counties Served: NYC-Five Boroughs 212-676-2135	Onondaga County Tobacco Education and Action Syracuse, NY Counties Served: Onondaga 315-435-3280	Tobacco Action Coalition of the Finger Lakes Rochester, NY Counties Served: Ontario, Seneca, Wayne, Yates 716-442-4260
Communities for a Tobacco-Free New York State White Plains, NY Counties Served: Putnam, Orange, Westchester, Rockland 914-949-2150 ext. 209	Project Action Amsterdam, NY Counties Served: Montgomery, Fulton, Hamilton 518-841-7145	Tobacco Prevention Awareness & Cessation Coalition Watertown, NY Counties Served: Jefferson, Lewis 315-786-3710
Erie-Niagara Tobacco-Free Coalition Buffalo, NY Counties Served: Erie, Niagara 716-858-6180	Rural Health Network Oswego, NY Counties Served: Oswego 315-349-8246	Ulster County Tobacco Control & Prevention Kingston, NY Counties Served: Ulster 914-340-3160

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The "RP" modifier has previously been used when claiming for the dispensing of a complete pair of eyeglasses due to loss, theft, or damage. The policy for the use of this modifier has been expanded to require that the "RP" modifier be used when individual component parts of eyeglasses (lenses and/or frames) are repaired or replaced due to change of refraction or damage to the component(s). The "RP" modifier should be affixed to the procedure codes for the materials. When billing for these repair/replacement situations of less than a full pair of eyeglasses, procedure code 92370 (repair and refitting of spectacles) must be used. The reason for the repair or replacement must be documented in the patient's records. For those optical providers using the Wallkill Optical Laboratory, the reason for the order for replacement components for eyeglasses must be notated on the prescription order form. If you have any questions regarding this policy you may call 518-473-5953.

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Pursuant to revised NYS General Business Law, effective January 1, 2000, Medicaid policy is revised as follows:
Hearing aid(s) shall be provided to the recipient for a trial period of at least forty-five days prior to billing for the aid by the dispenser.
Please retain this notice in your MMIS Hearing Aid Provider Manual. Questions can be directed to the Bureau of Program Guidance at (518) 486-3209.

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As a result of a rate adjustment retroactive to January 1, 1999, the number of billing units for Epogen was increased from 24 to 99. Remember that each billing unit is equal to 1000 service units of the drug. The Epogen rate codes are 3106 for hospital-based providers and 1806 for freestanding clinics. Adjustments need to be made to those "paid" claims that were billed without this new standard in mind. REMEMBER, IN THIS INSTANCE, THE CORRECT MANNER TO RECEIVE ADDITIONAL FUNDS IS TO ADJUST YOUR PREVIOUSLY PAID CLAIMS. DO NOT VOID ANY PREVIOUSLY PAID CLAIMS AND THEN TRY TO RESUBMIT THESE VOIDS AS NEW CLAIMS. If you need additional clarification of this issue, contact Ron Kaiser, of the Bureau of Medical Review and Payment, at (518) 474-8161.

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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