Provider Update Newsletter

May 2000, Volume 91

All Providers

HIPAA Highlights
DHS Website

GPA Claims

Haldol Decanoate injections

Billing updates

You are likely aware that Congress passed the Administrative Simplification Act of 1996 which was aimed at creating national, standardized, health care claim reporting formats. While it has taken several years to define all the required fields for the new reporting, it appears that final rules and standards will be issued in June 2000. We encourage you to visit the following Web sites for more information. The Provider Update will also publish requirements as they become known and will notify you of DHS and EDS activities as they relate to changes in claim submission.

The websites are as follows:

1. Washington Publishing Company: www.wpc-edi.com/HIPAA
2. EHNAC – Electronic Healthcare Network Accreditation Commission: www.ehnac.org
3. DHHS/HCFA – search on HIPAA @: www.hcfa.gov

The Department of Human Services’ (DHS) Website is still available while undergoing revisions. Please forward your comments and suggestions to the webmaster at webmaster@rixix.sod.eds.com.

Notification to General Public Assistance Providers

Beginning May 1, 2000, all claims for services provided to General Public Assistance (GPA) Recipients with dates of service on or after May 1, 2000 should be billed to EDS using your Medical Assistance Provider ID. The address for paper claims submissions beginning May 1, 2000 can be found in your Provider Reference Manual. All electronic claims submitters will be able to submit GPA claims along with claims for Medicaid Recipients. Pharmacy providers may submit those claims through POS beginning May 1, 2000. All other providers submitting electronically may bill through their current electronic claims submission method, including Provider Electronic Solutions software.

For dates of service through April 30, 2000, all providers for GPA Recipients should continue to submit claims to the Department of Human Services for processing. If you have questions regarding claims submissions for GPA services through April 30, 2000 please contact the Department of Human Services at (401) 462-1891. The change only effects claims processing, it does not impact reimbursement.

Mental Health Providers

When billing for Haldol Decanoate injections (J1631) provided by community mental health centers, HCPC code J1631 should be used, not HCPC code J1630, which is for 5 mg of haloperidol lactate injections. Community Mental Health Centers should not be using the code J1630 for Haldol Decanoate injections.

Procedure code J1631 can be billed for 1 to 10 units of 50mg of Haldol Decanoate. As of 2/1/00, J1631 is reimbursed at $32.78 per 50 mg injected. Prolixin Decanoate J2680 is reimbursed at $23.69 for up to 25 mg.

For any question please contact the Customer Service Help Desk at (401) 784-8100 for instate and long distance callers or 1-800-964-6211 for instate toll calls and border communities.

Pharmacy Providers

When billing for Procter & Gamble Pharmaceutical’s Helidac, NDC # 00149-0495-01, the units should be billed as 56, which represents the number of doses in a box. The box contains 14 blister packs, each containing 16 pills, for a total of 224 pills. Each blister pack represents the daily dose of pills to be taken by the patient with the total treatment regimen of 56 doses.

Also when billing for a Pulmicort Inhaler, NDC 00186-0915-42, the unit billed should be one.