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

Office of Medicaid Management
DOH Medicaid Update
February 2000 Vol.15, No.2

State of New York
George E. Pataki, Governor

Department of Health
Antonia C. Novello, M.D., M.P.H., Dr. P.H.
Commissioner

Medicaid Update
is a monthly publication of the
New York State Department of Health,
Office of Medicaid Management,
14th Floor, Room 1466,
Corning Tower, Albany,
New York 12237



ATTENTION: PRACTITIONERS, HOSPITALS AND PHYSICIAN GROUPS
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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


CSC BILLING BULLETIN
Request for Provider Suggestions
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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 TopicsDatePage
90-day Submission RemindersNovember 19972
Adjustment/VoidsMarch 19986
Billing Questions/Training - Regional Representative and Inquiry Unit Availability September 19971
Claim Correction FormsOctober 19988
Computerizing Medicaid BillingJanuary 19981
CSC Inquiry Unit Phone NumbersDecember 19994
Edit Review Panel (Edits 00127, 00262, 01281 and 01283)February 19993
Managed Care Related Remittance Statement Messages (Edits 01172 and 01173)November 19994
Other Insurance RemindersMay 19983
Physician Specialty Codes (Edits 00297, 00299, 00135 and 01154)August 19976
Place of Service CodesNovember 19986
Prior Approval Purge CriteriaDecember 19971
Provider Manual UpdatesJuly 19972
Staff Available for Seminars/AssociationsDecember 19984
Timing Is EverythingOctober 19993
Transportation -Edit 00244 - PA Not On File August 19986
Utilization Threshold (UT) - Common Questions, Edit 01154 Pends/DenialsApril 19973
Utilization Threshold (UT) - RemindersMarch 19971-2
Valid AttachmentsJune 19991

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.

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


TOBACCO FREE AWARENESS
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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.


NEW YORK STATE MEDICAID
VIAGRA EDIT CHANGE
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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 31st day as the DUR system will reject them as Therapeutic Duplications. Do NOT override. Claims filled prior to the 31st 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 31st day are NOT permitted.

ATTENTION: PHARMACY AND DME PROVIDERS OF ENTERAL FORMULAE
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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
AttainFiberlanLonalac PowderProBalance
Bio-care (powder)FibersourceMeritene LiquidProfiber Liquid
BoostFibersource HNMeritene PowderPromote
Boost High Protein Liquid Forta Drink PowderNitrolanPropac Powder
Boost High Protein PowderForta Shake PowderNuBasics 2.0Resource
Boost PuddingGlytrolNuBasics Juice DrinkResource for Kids w/Fiber
Boost w/FiberIsocalNuBasics VHPResource Diabetic
CitrisourceIsocal HN Plus NutramigenResource for Kids
EnliveIsocal HNNutren 1Resource Fruit Bev.
EnsureIsolanNutrilanSustacal
Ensure High ProteinIsomil OsmoliteSustacal Powder (Basic)
Ensure HNIsosourceOsmolite HNSustacal Pudding
Ensure LightIsosource HNOsmolite HN PlusSustacal w/Fiber
Ensure PowderJevityPediasureSustagen Powder
Ensure PuddingJevity PlusPediasure w/ FiberUltracal
Ensure w/ FiberKindercalPortagen PowderUltracal HN Plus

#Category I - NATURAL INTACT PROTEIN/PROTEIN ISOLATES
ITEM CODE B4151 MRA 1.3245/ONE CALORIC UNIT
Compleat ModifiedProSobee
Compleat-BVitaneed

#Category II - INTACT PROTEIN/PROTEIN ISOLATES (CALORICALLY DENSE)
ITEM CODE B4152 MRA 0.4046/ONE CALORIC UNIT
Boost PlusIsosource 1.5NutrAssist 1.5Scandi Shake(pow)
ComplyMagnacalNutren 1.5Sustacal Plus
Deliver 2.0Magnacal RenalNutren 2.0TwoCal HN
Ensure PlusNovaSource 2.0Resource PlusUltralan
Ensure Plus HNNuBasics PlusRespalor 

#Category III - HYDROLIZED PROTEIN/AMINO ACIDS
ITEM CODE B4153 MRA 2.0271/ONE CALORIC UNIT
Criticair HNNeocatePeptamen 1.5 Diet Vital HN
Glutasorb RTUNeocate One + LiquidPepticalVivonex Pediatric
Isotein HN PowderNeocate One + PowderReabilan 
L-Emental NutriVirSubdue 
L-Emental PediatricOptimentalTravasorb HN 

#Category IV - DEFINED FORMULAE FOR SPECIAL METABOLIC NEED ITEM CODE B4154 PRICED BY REPORT/ONE CALORIC UNIT
80056 ImpactOS 2ReGain Plus
AcerflexIsosource VHNPeptamen Renalcal
AdveraL-Emental HepaticPeptamen JrRe-Neph
AlimentumLipisorb LiquidPeptamen VHPRe-Neph Free
Alitraq PowderLipisorb PowderPerativeReplete
Amin Aid PowderLofenelac PowderPeriflex (powder) Resource Select
Analog FormulasLorenzo OilPhenex 1SandosourcePeptid
Choice DMMaxamaid (powder)Phenex 2Stresstein Powder
Citrotein PowderMaxamum(powder)PhenyAde PowderSuplena(Replena)
Cyclinex-1MSUD Diet PowderPhenylfree PowderTraumacal
Cyclinex-2MSUD MaxamumPKU2Traum-Aid HBC
DiabetisourceMSUD-1 PowderPregestimalTravasorb Hepatic
DuocalMSUD-2 PowderProduct 80056 Travasorb -MCT
EleCare PowderNeproPro-PeptideTravasorb Renal
Elemental 028 ExtraNovaSource PulmonaryPro-Peptide VHNVivonex Plus
GlucernaNovasource RenalPropimex 1 (powder)Vivonex TEN
Glucerna OSNutrihepPropimex 2 (powder) XMET Maxamaid
Hepatic-Aid PowderNutriVentPulmocareXMET Maxamum
Immun-AidOS 1Reabilan-HNXP Maximum

#Category V - MODULAR COMPONENTS ITEM CODE B4155 PRICED BY REPORT/ONE CALORIC UNIT
Casec PowderHPF PlusModucal PowderProduct 3232A
Egg/Pro PowderImmunocal Phlexy-10 CapsulesProMod Powder
Essential Pro PlusJuvenPhlexy-10 Drink MixReSource Inst Protein Pow
Essential ProteinLipomulPolycose LiquidRoss Carbohydrate Free
Gevral Protein PowMCT OilPolycose PowderSoyPro
Hom 2 MicrolipidProCel PowderSumacal

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

Not otherwise classified - REQUIRES PRIOR APPROVAL ITEM CODE B9998 PRICED BY REPORT
Apple FiberLactAid tabletsSorbitol 70%
FlavonexNeoCalgluconVivonex flavor pkts

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

The Medicaid Update: Your Window Into The Medicaid Program

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