Provider Update Newsletter
January 2006, Volume 159
All Providers
HIPAA Code Sets Conversion
Coming Soon!!!...Provider Education Days
Pharmacy Providers
Medicare Part D & Benefit Coverage
for Optional Drug Classes Effective January 1, 2006
Independent Laboratory Providers
Billing for Urine Testing for
Substance Abuse
HIPAA Code Sets Converstion
HIPAA (Health Insurance Portability & Accountability
Act) mandates that all states eliminate
the use of their local procedure codes and local modifiers except as
specifically provided
within 42 CFR (Code of Federal Regulations).
The purpose of local procedure code mapping is to attempt to crosswalk
the RI local codes
to any existing or new National HCPCS, CPT, ADA or other National Code
Sets. There
are some local codes that will remain due to the code being non-medical
or no appropriate
national code crosswalk.
DHS and EDS have completed the crosswalk of our Local Codes/Modifiers to
National
Code Sets. We have performed financial analyses to ensure that provider
reimbursements
reflect current Medicaid policy and budget allotments.
EDS is moving toward a May 2006 implementation date and expects a smooth
transition.
To keep providers informed we will be utilizing the following forms of
communication
which include the monthly Provider Updates, the
DHS website, the Banner Page of the
Remittance Advice and mailings direct to your office.
Provider specific mailings to watch for will be the code crosswalks and
workshop information
in February/March 2006. Educational workshops will be held in April
2006.
If you have recently moved or will be moving within the next 6 months,
please notify our
Provider Enrollment Department with your current address to ensure you
receive all the
appropriate mailings. To change or update your address please print a
Change of Address
form from the DHS website by clicking
here
and mailing it to:
Electronic Data Systems
Provider Enrollment Unit
PO Box 2010
Warwick, RI 02887-2010
Coming Soon!!!...Provider Education Days
Could you use assistance interpreting your
Remittance Advice?
Are you interested in learning more about Electronic Transactions, i.e.
electronic billing,
web eligibility, checking claim status or prior authorization status on
the web?
Would you like to learn more about Claim Check?
Would you like to better understand Surveillance Utilization Review (SUR)?
You can put a face to the name and meet your Provider Representative by
joining us here
at EDS. You can also find your Provider Representative on the DHS
website by
clicking
here.
If you answered yes to any of the questions above, then plan on
attending Provider
Education Days. Mark your calendars for Thursday February 16th.
There will be booths with information, seminars for you to attend, web
demonstrations
and more.
Medicare Part D & Benefit Coverage for
Optional
Drug Classes Effective January 1, 2006
Effective January 1, 2006 the new Medicare Part D
Prescription Drug Plans (PDP) coverage,
Part D, begins for all Medicare beneficiaries, including those
beneficiaries eligible for both
Medicare and Medicaid. State Medicaid coverage for prescription
medications for dually
ligible beneficiaries ends on December 31, 2005, with limited
exceptions.
At this time the Rhode Island Department of Human Services Medicaid
Program will continue
coverage of medications in the following classes of Optional Drugs:
Benzodiazepines
Barbiturates
Cough & Cold medications
Prescription vitamins & mineral products, except prenatal vitamins and
fluoride prepartions
Over-the-Counter Medications
Weight Loss / Anti-Obesity Agents*
Please note that coverage in these drug classes is limited to those
medications currently
covered by the Rhode Island Department of Human Services Medical
Assistance Program.
* these medications will continue to be covered through the Pharmacy
Prior Authorization
(PA) Program; PA forms are available on the DHS Website by clicking
here.
Billing for Urine Testing for Substance
Abuse
The following codes should be utilized by clinical
laboratories billing RI Medicaid through the
Department of Human Services (DHS) for laboratory testing performed for
licensed substance abuse treatment programs.
This directive is for substance abuse facilities that are conducting
services not included in the
Department of Mental Health, Retardation and Hospitals (MHRH) methadone
treatment bundled rate.
The following codes should be used for urine testing for drugs of abuse:
|
Procedure Code |
Description |
| 80101 |
DRUG, SCREEN; SINGLE DRUG CLASS, EACH DRUG
CLASS *Maximum of 9 units |
| 82570 |
CREATININE URINE |
| 82055 |
ALCOHOL (ETHANOL); ANY SPECIMEN EXCEPT
BREATH |
| 83986 |
PH, BODY FLUID, EXCEPT BLOOD
In addition Gas Chromatography/Mass Spectromotry is the
generally accepted method of testing in order to bill RI
Medicaid using the CPT codes below |
| 82205 |
BARBITURATES, NOT ELSEWHERE
SPECIFIED |
| 80154 |
BENZODIAZEPINES |
| 83925 |
OPIATES, (EG, MORPHINE, MEPERIDINE) |
| 83840 |
METHADONE |
| 82145 |
AMPHETAMINE OR METHAMPHETAMINE |
| 82520 |
COCAINE OR METABOLITE |
|
