DOH Medicaid Update January 2003 Vol. 18, No.1

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The Provider Outreach staff at Computer Sciences Corporation (CSC) contributes this CSC Billing Bulletin to the Medicaid Update 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:

Or, you may fax your suggestions to:

Suggested topics and billing questions will be addressed in future CSC Billing Bulletin articles.

Questions regarding policy and enrollment 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.

Questions regarding the Medicaid Eligibility Verification System (MEVS) should be directed to (800) 343-9000.

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.

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• Procedure Code 08670 Periodic orthodontic treatment visit (as part of contract).

  This code can be billed quarterly for a maximum of three years and can only be billed four (4) times in a 12 month period beginning 90 days after the date of service on which orthodontic appliances have been placed for active treatment.

  Claims billed more frequently than the allotted four times per year will result in an automatic systems denial for Edit Reason 00710 - Procedure exceeds service limits.

• Procedure Code 09920 Behavior management (OMRDD client identification form required)

  This is a per visit incentive to compensate for the greater knowledge, skill, sophisticated equipment, extra time and personnel required to treat this population. This fee will be paid in addition to the normal fees for specific dental procedures. For purposes of the Medicaid program, the developmentally disabled population for which procedure code 09920 may be billed is limited to those who receive ongoing services from community programs operated or certified by the New York State Office of Mental Retardation and Developmental Disabilities (OMRDD). These include, among others, family care programs, programs operated directly by the State, programs operated by agencies such as the Association for Retarded Children (ARC), and private schools. To identify patients who are eligible for services billed under MMIS procedure code 09920, OMRDD has provided these individuals with special identification forms. In order to ensure the proper use of this procedure code, a copy of the completed OMRDD client identification form must be attached to each claim submitted to MMIS under procedure code 09920. You also should maintain a copy of this form with the patient's record.

If you have any questions, please call the Bureau of Medical Review and Payment at (800) 342-3005, option #3.

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The Medicaid program reimburses for drugs furnished by physicians to their patients on the basis of the acquisition cost to the practitioner of the drug dose administered to the patient. For all drugs furnished in this fashion, it is expected that the physician will maintain auditable records of the actual itemized invoice cost of the drug, including the numbers of doses of the drug represented on the invoice.

To facilitate electronic claim submission and timely payment to physicians, the Medicaid program consults national pricing references such as First DataBank to establish a maximum reimbursable amount (MRA) on its procedure code reference file. Claims submitted for most physician-supplied drugs will be paid automatically up to the MRA price. However, drugs listed in the Medicaid Physician Fee Schedule with a notation of BR (By Report) under the Maximum Fee column must be submitted on a paper NYS MMIS HCFA 1500 Claim Form, with a copy of the itemized invoice as documentation.

It is important to remember that, regardless of whether a particular drug is designated as BR (By Report) in the Medicaid Physician Fee Schedule, Medicaid does NOT intend to pay more than the acquisition cost of the drug dosage, as established by invoice, to the practitioner. Regardless of whether an invoice must be submitted to Medicaid for payment, the physician is expected to limit the charged amount to the actual invoice cost of the drug dosage administered.

If you have any questions, please call the Bureau of Medical Review and Payment at (518) 474-8161.

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According to a study conducted by the Pediatric Asthma Care Patients Outcomes Research Team (PORT) exposure to household asthma triggers continues to be a significant problem, with few parents adopting environmental control measures to reduce allergen exposure. In the PORT study of 638 children (ages 3 to 15 years) with asthma, 30 percent lived in households that included a smoker, 18 percent had household pests (cockroaches or mice), and 59 percent had furry pets. Also noted, 45% of the parents had received instructions about avoiding asthma; unfortunately, receipt of instructions about how to reduce environmental triggers was not associated with efforts to do so.

Asthma rates have increased in the past two decades and are highest among poor, urban and minority populations. Mounting evidence suggests that indoor allergens and irritants contribute to childhood asthma. Exposure to environmental tobacco smoke has consistently been shown to increase asthma risk for children. Studies have also implicated dust mites, cockroaches, mice, cats and other furry pets.

The National Asthma Education and Prevention Program (NAEPP) guidelines, first disseminated in 991, highlight the reduction of environmental triggers as part of a comprehensive approach to asthma treatment. Recent asthma care improvements have focused predominately on appropriate Pharmacotherapy. Less attention has been focused on reinforcement and follow through on the need to minimize asthma patients exposure to environmental triggers.

Exposure to potential environmental triggers is common, and parents of children with asthma infrequently adopt recommended trigger avoidance measures. While specific exposures may vary with demographic and socioeconomic variables, all children are at risk. These results confirm the need to further develop effective educational strategies to utilize with parents of children with asthma to reduce indoor environmental triggers.

For successful long-term asthma management, it is essential to identify and reduce exposures to relevant allergens and irritants and to control other factors that have been shown to increase asthma symptoms and/or precipitate asthma exacerbations. Using the correct medications, reducing exposure to triggers and learning how to manage asthma as a chronic disease can reduce the frequency and severity of asthma symptoms.

Source: Archives of Pediatric and Adolescent Medicine March 2002, 156, pp.258-264.

The Medicaid program reimburses for medically necessary care, services and supplies needed in the diagnosis and treatment of asthma. For information regarding Medicaid payment of these services, please contact the Bureau of Program Guidance at (518) 474-9219.

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In November 2002, the U.S. Department of Health and Human Services (HHS) launched the first national diabetes awareness and prevention campaign designed to promote lifestyle changes as a way to prevent the onset of adult-onset diabetes among all people, but particularly among Hispanics and other minorities. The campaign called, "Small Steps, Big Rewards", encourages daily physical exercise and a healthier diet to prevent type 2 diabetes.

Nationally, 17 million people have diabetes, 16 million of which have type 2 diabetes. An additional 16 million people have pre-diabetes, a condition that raises a person's risk of developing type 2 diabetes. The diabetes rate nationwide has increased 50% in the past decade and is expected to increase to an additional 165% by 2050 if the current rate continues.

The new campaign is jointly sponsored by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) and will be run by the National Diabetes Education Program (NDEP). The "Small Steps, Big Rewards" campaign grew out of the finding of HHS' Diabetes and Prevention Program (DPP) clinical trial. The study, sponsored by NIH, showed that people with pre-diabetes can delay and possibly prevent type 2 diabetes by losing five to seven percent of their body weight through moderate changes in diet and exercise. The NDEP involves more than 200 public and private sector partners who work at the national, state, and local level.

The "Small Steps, Big Rewards" campaign will include tools to help people make lifestyle changes, a kit to assist providers educate patients about diabetes, web-based resources for providers and consumers, and public awareness announcements on TV, radio and in print.

The NDEP is seeking partners to educate people with diabetes and their families on how to control their diabetes. You can help spread the message about healthy living with diabetes by distributing campaign materials to your members, constituents, patients, health professionals, local media and other community organizations.

Just go to the National Diabetes Education Program website for valuable free materials and information on how to join the campaign: http://www.ndep.nih.gov/.

The Medicaid program reimburses for medically necessary care, services and supplies for the diagnosis and treatment of diabetes. For information regarding Medicaid coverage of services related to diabetes, please contact the Bureau of Program Guidance at (518) 474-9219 or go to:

http://www.health.state.ny.us/health_care/medicaid/program/2000/oct2000.htm

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Arthritis is the leading cause of disability in New York State and in the nation. It accounts for enormous health care and costs for individuals, their families, and the State. Unfortunately, many people with arthritis believe that there is nothing that they can do to manage their disease, but there is.

Physical activity, weight control, and self-management can help people with arthritis function better and stay productive. Research has suggested that diet and exercise choices can help reduce pain and improve mobility. Contrary to popular belief, regular exercise helps, not hurts, most older adults. Those with chronic diseases, such as arthritis, may actually improve or maintain their functioning level, but should first check with their physician before embarking on a physical activity regimen.

The Surgeon General states that significant health benefits can be obtained by including physical activity in your routine on most days of the week and recommends that adults achieve 30 minutes of moderate physical activity per day. For those beginning a physical activity routine, it may be helpful to break the recommended amount of time into intervals, such as three 10-minute segments of time. The Surgeon General reports that regular physical activity is necessary to maintain normal muscle strength, joint structure, and joint function. Walking and bicycling are particularly good activities for people with arthritis because these are aerobic/endurance activities, which, if done regularly, strengthen the heart and control weight.

The five Arthritis Foundation chapters across New York State offer a variety of services and programs that are available to people with arthritis, their families, and others who want to increase their knowledge of this disease. Each chapter offers the Arthritis Self Help Course (ASHC). ASHC is a six-week course that teaches people how to manage their arthritis and lessen its effects. ASHC has been proven to reduce the pain associated with arthritis by 40% and reduce physician visits for arthritis by 20%.

For more information about ASHC or other programs and services contact your local chapter. For more information about arthritis and other rheumatic conditions, visit the New York State Department of Health website at www.health.state.ny.us/diseases/conditions/arthritis/index.htm or call the Arthritis Program at (518) 408-5141.

ARTHRITIS FOUNDATION NEW YORK STATE CHAPTERS

New York Chapter 122 East 42nd St., 18th Floor NY, NY 10168 (212) 984-8700 Serving: the five Boroughs of New York City, Westchester, Sullivan, Rockland, Orange, Dutchess, Ulster, and Putnam Counties Hudson Valley Branch Burke Rehab Center 785 Mamaroneck Rd. White Plains, NY 10605 (914) 683-8462	Upstate NY Chapter 3300 Monroe Ave., Suite 319 Rochester, NY 14618 (585) 264-1480 Serving: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Seneca, Wayne, Wyoming, and Yates Counties Buffalo Branch 462 Evans St. Williamsville, NY 14221 (716) 626-0333
Long Island Chapter 501 Walt Whitman Rd. Melville, NY 11747 (631) 427-8272 Serving: Nassau and Suffolk Counties	Central NY Chapter 5858 East Molloy Rd. #123 Syracuse, NY 13211 (315) 455-8553 Serving: St. Lawrence, Jefferson, Lewis, Oswego, Cayuga, Onondaga, Madison, Oneida, Herkimer, Cortland, Tompkins, Chenango, Broome, Tioga, Steuben, and Chemung Counties Broome County Branch Lourdes Hospital 161 Riverside Dr., Rm. M02 Binghamton, NY 13905 (607) 798-8048
Northeastern NY Chapter 1717 Central Ave., #105 Albany, NY 12205 (518) 456-1203 Serving: Albany, Columbia, Delaware, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington Counties

 

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Medicaid Developing HIPAA Compliant PACES Software

The Office of Medicaid Management and its fiscal agent, Computer Sciences Corporation, have initiated a project to develop a HIPAA compliant replacement for the current PACES software. The replacement software, ePACES, is a web-based application that will provide targeted Medicaid Eligibility Verification System (MEVS) capabilities as well as and the existing PACES application. The ePACES application will allow submission of HIPAA 'Dental' 'Professional' and 'Institutional' claim formats. New York Medicaid providers using the PACES software will be asked to switch to the new ePACES application or another HIPAA compliant format if they prefer.

ePACES pilot testing with a selected number of providers will begin in April 2003. We intend to begin ePACES implementation when testing is complete for ePACES, the MMIS and eMedNY processing systems. We will continue to accept claims via PACES until October 16, 2003. After this date we will only accept HIPAA compliant transactions. These can be produced with either the new ePACES application or any other process you may have that will generate HIPAA compliant transactions.

The framework of the ePACES application will be on a browser base. No software will be installed on the providers' computers. Accordingly, providers will need Internet access as well as an Internet browser that will support encryption of 128-bit (Internet Explorer 4.01 and above, Netscape 4.7 and above). You must have a minimum connection speed of 28.8K.

ePACES functionalities will support the following HIPAA transactions:

270 & 271    Eligibility (Inquiry & Response)
276 & 277   Health Care Claim Status (Inquiry & Response)
278             Service Authorizations and DVS (Inquiry & Response)
837            Claims (Institutional, Professional, Dental)

Additional information will be provided on ePACES as we proceed with its development. Please check our HIPAA website for updates on ePACES and other Medicaid HIPAA activities.

HIPAA Timelines

Companion Guides - Drafts of the 837, 834, 835, 820 and 276/277 companion guides should be available on the HIPAA website by early January, 2003. Draft versions of the rest of the transactions will be available late January, early February. Please remember that these documents will be in draft form and are subject to change.

Testing - The HIPAA transactions testing process will begin by, or prior to, April 16, 2003. Initially we will conduct pilot testing with a selected number of providers. Between April and October 2003, we expect to test with all our providers. We encourage providers to expedite their HIPAA compliant efforts to insure that they will be able to test successfully with Medicaid. If you use the services of a vendor, make sure to maintain regular communications and monitor his/her compliance progress.

Medicaid Training - Medicaid HIPAA provider training is scheduled to begin in early March 2003. The training will be held regionally and will focus only on changes in Medicaid billing requirements necessitated by the HIPAA legislation. The training will be fairly intensive and we expect attendees to have knowledge of the HIPAA implementation guides that may pertain to their area of service. A tentative schedule will be posted on our HIPAA website as soon as it becomes available.

New York Medicaid website is www.emedny.org/index.html.

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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 Seminar. 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

The scheduled seminar will be held:

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

The seminar will last approximately two hours . Direct questions about these seminars to CSC as follows:

Please complete the registration information using the link to the form below:

To register, please mail the completed page to:

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

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

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

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Did you miss a pertinent article during the year 2002? Listed below is an index of articles, by provider specialty or subject area. These articles can be located:

• on the Department of Health website at: http://www.health.state.ny.us/health_care/medicaid/index.htm
• or by request, by emailing your address to: MedicaidUpdate@health.state.ny.us
• or by telephoning (518) 474-9219.

Please note that articles containing invitations to date-specific events are not listed, as these events have already occurred.

PROVIDER/SUBJECT     ARTICLE      MONTH     

All Providers

• Co-Payment Policy: A Review of Policy and Procedure    January 2002
• Department Website Offers Easy Access    January 2002
• Department Website Offers Easy Access    April 2002
• Change Your Address and Notify Medicaid    March 2002
• Medicaid Denies Payment...Can I Bill the Medicaid Recipient    April 2002
• All Providers Must Disclose Ownership and Control Changes    April 2002
• Index of 2001 Medicaid Update Articles    April 2002
• Do You Bill on Paper Claim Forms    May 2002
• Electronic Billing Transmission: Some Reminders    May 2002
• Hepatitis C Treatment Options and Considerations    May 2002
• Have Your Received a Claim Correction Form    June 2002
• EMEVS PC Applications: Error Code File has been Updated    June 2002
• Provider Manual Update: Prior Approval Contact and Inquiry    June 2002
• Healthy NY: Health Care for Working New Yorkers    July 2002
• All Providers Changing Your Address    July 2002
• New York's Health Care Proxy Form    July 2002
• Our 900 Service Line Telephone Number has Been Changed    August 2002
• Recipient Responsible to Show Medicaid Card    August 2002
• Tape and Diskette Submissions    September 2002
• The New eMedNY is Coming in November    October 2002
• Medicaid to Discontinue Mailing of the List of Disqualified Prescribers    October 2002

Asthma

• Asthma: The Use of Spirometry for Diagnosis and Management    January 2002
• Asthma: Success with St. John's Riverside Hospital    February 2002
• Asthma: List of 2001 Articles    March 2002
• Student Athletes and Exercise-Induced Asthma    March 2002
• Summary of Guidelines: Diagnosis and Management of Asthma    April 2002
• Free Asthma Materials Available    June 2002
• Asthma Triggers and Assessment Questions    July 2002
• National Asthma Guidelines Released    August 2002
• Regional Asthma Coalitions in NYS    September 2002
• Asthma Action Plan is Recommended    October 2002
• Key Indicators for Diagnosis of Asthma    November 2002
• Guidelines for the Diagnosis and Management of Asthma    December 2002

Clinic

• Billing for Magnetic Resonance Imaging    May 2002
• New Edits Will Impact Clinic Claims    June 2002
• Outpatient Chemical Dependency Services    December 2002

Comprehensive Case Management

• Clarification of Remittance Messages    January 2002
• Payment Guidelines    March 2002

Dental

• New Instructions for Billing and Coverage    May 2002
• Dental Reimbursement: Sealants and Evaluations    July 2002
• Clarification of Dental Services for Managed Care Enrollees    August 2002
• Dental Prophylaxis Billing    August 2002
• Reimbursement of "By Report" Dental Codes    December 2002

Diabetes

• Diabetes: Women Can Reduce Their Risk    January 2002
• Diabetes and the Medicaid Program: List of 2001 Articles    February 2002
• Diabetes Management: Intensive Therapy and Team Approach    February 2002
• Diabetes: High Hospitalization Rates in Children    March 2002
• Aspirin Therapy in Diabetes    April 2002
• The Diabetes Resource Coalition of Long Island    May 2002
• Reduction of Incidence of Type 2 Diabetes    July 2002
• Diabetes Condition Recognized    August 2002
• Free Diabetes Foot Screening Materials    September 2002
• List of Coalitions for Diabetes    October 2002
• Initiative for Children with Diabetes    November 2002
• Diabetes Poor Health Literacy And Complications    December 2002

Durable Medical Equipment

• Classification of Enteral Products    February 2002
• Bed Rail Safety Equipment for the Developmentally Disabled    March 2002
• Provider Manual Revisions    March 2002
• Fee for Prosthetic    May 2002
• Payment for Durable Medical Equipment in Facilities    June 2002
• Ordering and Providing Supplies: Frequency and Quantity Limits    June 2002
• Breast Pump Rental Reimbursement    July 2002
• Enteral Billing    August 2002
• New Fee for DME Providers    September 2002

Family Health Plus    

• Disaster Relief Medicaid/Family Health Plus    March 2002
• Are You Interested in Participating in Family Health Plus    March 2002

HIPAA

• HIPAA News Compliance Date is Extended    June 2002
• HIPAA News    July 2002
• HIPAA News    August 2002
• HIPAA Compliance Information    October 2002

Home And Community Based Waiver

• Long Term Home Health Care: Need for Information    May 2002
• New Restriction/Exception Code    July 2002

Hospital

• Hospital Patient Discharge Status Codes    September 2002

Laboratory

• Laboratories: Payment for Latest FDA-Approved HIV Viral Load Test    March 2002
• Payments for Referred Laboratory Testing May be Available    June 2002
• Laboratory Regulations Revision    September 2002
• Laboratory Billing for Molecular Diagnosis Procedures    September 2002
• Additional HIV Test Covered    November 2002
• Laboratory Payment for HIV Test    December 2002

Managed Care

• Managed Care Changes for Alcohol and Substance Abuse Services    April 2002
• List of Managed Long Term Care Providers    April 2002
• Clarification of Dental Services for Managed Care Enrollees    August 2002
• Managed Care Benefits Package Amended    September 2002
• Providers in Oneida County and Surrounding Areas Update on Kids Oneida    December 2002

Midwife

• Midwives and New Procedures    May 2002

Nurse Practitioner

• Billing for Botulinum Toxin B (Myobloc)    July 2002

Nursing Home

• Guidelines Governing Payment of Nursing Home Claims    December 2002

Ophthalmologist

• Billing Guidelines for Eyeglass Project    December 2002

Optometrists

• Optometrists Who Prescribe: Special Instructions    February 2002
• Optometrists Who Prescribe: Special Instructions    May 2002
• Billing Guidelines for Eyeglass Project    December 2002

Ordered Ambulatory

• How to Request Sterilization and Hysterectomy Forms    May 2002
• Billing for Botulinum Toxin Type B (Myobloc)    July 2002
• Medicaid Increases Fees for Mammography Services    October 2002

Pharmacy

• Serostim Prior Authorization: Pharmacy Overdrive    February 2002
• Classification of Enteral Products    February 2002
• Care for Schizophrenia: Use Antipsychotics    February 2002
• Pharmacy Compound Prescription Billing Instructions    February 2002
• Pharmacy: Correct Billing for Non-drug Items    March 2002
• Provider Manual Revisions    March 2002
• Pharmacy: Answers to Common Questions    May 2002
• Ordering and Providing Supplies: Frequency and Quantity Limits Do Matter    June 2002
• Pharmacy Dispensing of Viagra: Review of Guidelines    June 2002
• New Medicaid Mandatory Generic Program to Begin    July 2002
• Pharmacy: Answers to Common Questions    July 2002
• Enteral Billing    August 2002
• Comparison of Brand Drugs vs. Generic Drugs    August 2002
• Patient Information on Generic Drugs    August 2002
• Pharmacists - Serostim and Zyvox Billing    August 2002
• New Medicaid Law - Mandatory Generic Drug Program    August 2002
• Mandatory Generic Program Date Changes    September 2002
• Comparison of Drug Costs    September 2002
• Pharmacists: Are You Billing with the Correct NDC Number?    October 2002
• Medicaid Mandatory Generic Drug Program    October 2002
• Hints for Using the Prior Authorization System    December 2002

Physician

• Enclosed Bed Systems are Dangerous    February 2002
• Serostim Prior Authorization: Prescriber Overview    February 2002
• Care for Schizophrenia: Use Antipsychotics    February 2002
• Bed Rail Safety Equipment for the Developmentally Disabled    March 2002
• Magnetic Resonance Imaging Billing    May 2002
• How to Request Sterilization and Hysterectomy Forms    May 2002
• Billing for Magnetic Resonance Imaging    May 2002
• Ordering and Providing Supplies: Frequency and Quantity Do Matter    June 2002
• Important Viagra Prescribing and Billing Information    June 2002
• New Medicaid Mandatory Generic Program to Begin    July 2002
• Physician Modifier Codes Used for Billing    July 2002
• Billing for Botulinum Toxin Type B (Myobloc)    July 2002
• Enteral Billing    August 2002
• Patient Information on Generic Drugs    August 2002
• Prescribers-Serostim and Zyvox Billing    August 2002
• New Medicaid Law Medicaid Mandatory Generic Drug Program    August 2002
• Are Your Patients Taking Their Medicine?    September 2002
• Medicaid Increases Fees for Mammography Services    October 2002
• Introduction to the Viral Prescription Pad    October 2002
• Medicaid Mandatory Generic Drug Program    October 2002
• Conditions for Ordering Enteral Nutrition    December 2002
• Hints for Using the Prior Authorization System    December 2002

Portable X-Ray

• Demonstration Program is Extended    September 2002

Private Duty Nursing

• Prior Approval for Private Duty Nursing    September 2002

Tobacco Cessation

• Smoking Cessation and the Medicaid Program: List of 2001 Articles    January 2002
• Minorities and Tobacco Use    January 2002
• Tobacco Free Awareness Materials    March 2002
• Smoking Cessation Coverage Highlights    April 2002
• Smoking Cessation: Free Patient Materials    July 2002
• Tobacco Use in Women and Girls    September 2002
• Open Letter from Commissioner Novello    September 2002
• Smoking Cessation Therapy Coverage    October 2002

Transportation

• Orderers of New York City Ambulette Transportation    January 2002
• Personal Assistance by Ambulette Staff    September 2002
• NYC City Rules for Ordering Transportation    December 2002

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Who Do I Call?

Onondaga County Department of Social Services has chosen Rural-Metro to process requests for transportation of Onondaga County Medicaid recipients.

For dates of transport on or after January 1, 2003, ordering practitioners should call:

Questions regarding this article should be addressed to the Provider Resource Unit at (518) 474-9219.

 

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On Saturday, November 16, 2002, the New York State Department of Health (DOH) and Computer Sciences Corporation(CSC) implemented Phase I of eMedNY. eMedNY is the new Medicaid system that will consolidate the Medicaid Management Information System (MMIS) with the Medicaid Eligibility Verification System (MEVS).

Phase I of eMedNY, the MEVS replaced the functionality previously provided by EMEVS and offers enhanced electronic claim capture and online adjudication capabilities for pharmacy claims. Online adjudication provides an immediate status response at the time of submission that allows pharmacy providers to determine if a claim is approved for final payment.

The DOH and CSC wish to take this opportunity to extend our appreciation to the Medicaid provider community who participated in, or who were impacted by, the implementation. Despite extensive testing, there were some system implementation issues that, in some instances, prevented providers from making full use of the new eMedNY functionality. The provider community reacted with the highest levels of patience and professionalism. DOH and CSC further wish to acknowledge those providers that continued to render medically necessary services to Medicaid clients during the eMedNY implementation period. Be assured that DOH and CSC representatives worked around the clock to quickly bring the new eMedNY system to its full capacity and functionality.

For more information about eMedNY, visit the website at www.emedny.org. The website contains the MEVS Provider Manual and the ProDUR/ECCA Manual. These manuals can be downloaded from the website. Other information available at the website includes: Medicaid news, frequently asked questions and answers, formulary file information, and DOH and CSC contact information.

Questions about MEVS transactions, pharmacy claims, connectivity, POS terminals and software should be directed to eMedNY Provider Services (Monday - Friday from 7:00 a.m. to 10:00 p.m., and Saturdays, Sundays and holidays from 8:30 a.m. to 5:30 p.m.) at the following telephone number: eMedNY Provider Services, (800) 343-9000.

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Prescribers (doctors, nurse practitioners, dentists, etc.) and pharmacists are reminded of policies they must adhere to when prescriptions are transmitted to a pharmacy by telephone or fax for Medicaid recipients.

Prescribers may telephone or fax prescriptions directly to pharmacies for Medicaid recipients unless otherwise prohibited by federal or State laws or regulations.

A follow-up signed written prescription must be on file at the pharmacy within five (5) business days for:

1. Prescriptions with refills.
2. Prescriptions for multi-source brand name drugs requiring "brand necessary" or "brand medically necessary".

Note: Telephone or faxed orders for OTC (over-the-counter) drugs are not permitted.

• PRESCRIBERS are responsible to provide the original written prescription within five (5) business days of a telephoned or faxed order.
• PHARMACISTS are required to have the original signed written prescription on file within five (5) business days of a telephoned or faxed order.

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When electronically billing for a prescription drug, the prior authorization number must be entered into the prior authorization field for the claim to be paid. This field has 12 values (NCPDP format). Pharmacists are reminded to enter into the prior authorization code field a "1", followed by the eight-digit prior authorization number, followed by three zeroes/copay exemption values. Claims that do not follow this format will be denied.

For billing questions, contact (800) 343-9000. For policy questions, contact the Pharmacy Policy and Operations staff at (518) 486-3209.

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• Entering the client identification number

Some providers have expressed difficulty in entering the client identification number (CIN) into the automated pharmacy prior authorization telephone response system. Providers are reminded to listen carefully to the voice prompt directions and follow the steps below:

• Verify that the format of the CIN is 2 letters, 5 numbers, 1 letter - e.g. AB12345C.
• USE THE KEYPAD TO ENTER ALL 8 VALUES AT ONCE. For letters, enter the corresponding number on the keypad. For Q, use 7 and for Z, use 9 (These letters are not visible on all keypads).
• AFTER ALL EIGHT VALUES HAVE BEEN ENTERED, the caller must define the first, second and eighth value by entering the number that represents the letter of the CIN. For example, the voice prompt will say "The first number you pressed was 2 - If you wanted an A, press 1. If you wanted a B, press 2".

Please contact us at (518) 486-3209 if you have questions after following these instructions.

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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