DHCS/MediCal & Palmetto/J1MAC News

The following information has been received by ANCO.


****DHCS/MediCal NEWS****
The Deficit Reduction Act (DRA) mandates that all physician-administered drug claims require a National Drug Code (NDC). In order to comply with the DRA, providers must bill for these drugs using the appropriate CPT-4, HCPCS Level II, or local HCPCS Level III codes and, in addition, must include the NDC on the claim form. Providers have been encouraged, for dates of service on or after September 1, 2008, to include the NDC code on the claim, but claims without an NDC code have still been paid. An analysis of providers’ voluntary NDC submissions (for dates of service on or after September 1, 2008) indicates that physician-administered drug claims are being submitted without the NDC. Providers are reminded that, claims with dates of service on or after April 1, 2009 that do not meet the NDC reporting requirements to include a valid NDC with a HCPCS code, will be denied. [FPACT only] HCPCS codes X1500 and Z7610 used by the Family PACT (Planning, Access, Care and Treatment) Progr
am do not require an NDC. For more information on NDC reporting, including FAQs, please visit the NDC page on the Medi-Cal Web site at: http://files.medi-cal.ca.gov/pubsdoco/ndc/ndc.asp

Note: Only those products manufactured by companies participating in the federal Medicaid rebate program are reimbursable under Medi-Cal. A list of manufacturers participating in the rebate program, which changes periodically, is available in the Medi-Cal part 2 manuals (General Medicine, Obstetrics and Outpatient provider manuals) under Drugs: Contract Drugs List Part 5 – Authorized Manufacturer Labeler Codes (drugs cdl p5) or on the Medi-Cal Web site at: http://files.medi-cal.ca.gov/pubsdoco/DocFrame.asp?wURL=publications%2Fmasters%2Dmtp%2Fpart2%2Fdrugscdlp5%5Fi00m00o00p00%2Edoc

Resources
The ASC X12N Version 4010A1 Companion Guides have been updated and are available on the Medi-Cal Web site at http://files.medi-cal.ca.gov/pubsdoco/hipaa/hipaaspecs_home.asp . Additionally, the September Part 2 provider bulletins (General Medicine, Obstetrics and Outpatient) include NDC information, physician-administered drug definitions, billing descriptions and examples for CMS 1500 and UB-04 paper claim forms, as well as both 837 Institutional and Professional electronic formats, and Section 340B information. These bulletins can be viewed on the Medi-Cal Web site at http://files.medi-cal.ca.gov/pubsdoco/Bulletins_menu.asp . Finally, the CMS 1500 and UB-04 claim form tutorials on the Medi-Cal Web site have been updated and can be viewed at: http://files.medi-cal.ca.gov/pubsdoco/eo/elearning.asp .

Provider Workshops
In addition, training workshops have been scheduled in January and February 2009 to address NDC reporting. The dates, times and locations of these workshops, and how to pre-register, can be found on the Medi-Cal Web site on the NDC page: http://files.medi-cal.ca.gov/pubsdoco/ndc/articles/ndc_9992.asp .

Should you have any questions or need additional information, please call the Telephone Service Center (TSC) at 1-800-541-5555 or visit the Medi-Cal Web site at the address listed above.


****PALMETTO/J1MAC NEWS****
1099 Forms for 2008
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Ohio%20Part%20B%20Carrier~Articles~General~1099%20Forms%20for%202008?opendocument

By January 31, 2009, your 2008 1099 from Palmetto GBA, LLC (serving as a
Medicare contractor for the Centers for Medicare & Medicaid Services (CMS))
will be mailed. Upon receipt, please review the document closely and
contact us immediately if you notice any discrepancies in your name, tax
identification number, or dollar amount reported.


Calendar Year (CY) 2009 Annual Update for Clinical Laboratory Fee Schedule
and Laboratory Services Subject to Reasonable Charge Payment
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~All%20Part%20A%20MLNs~Calendar%20Year%20(CY)%202009%20Annual%20Update%20for%20Clinical%20Laboratory%20Fee%20Schedule%20and%20Laboratory%20Services%20Subject%20to%20Reasonable%20Charge%20Payment%20?opendocument

MLN article 6070 is titled Calendar Year (CY) 2009 Annual Update for
Clinical Laboratory Fee Schedule and Laboratory Services Subject to
Reasonable Charge Payment. It provides instructions for the Calendar Year
(CY) 2009 clinical laboratory fee schedule, mapping for new codes for
clinical laboratory tests, and updates for laboratory costs subject to the
reasonable charge payment.


Claim Status Category Code and Claim Status Code Update
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~All%20Part%20A%20MLNs~Claim%20Status%20Category%20Code%20and%20Claim%20Status%20Code%20Update?opendocument

MLN article 6328, Claim Status Category Code and Claim Status Code Update,
applies to physicians, providers, and suppliers who bill Medicare
contractors (carriers, fiscal intermediaries (FI), regional home health
intermediaries (RHHI), Medicare Administrative Contractors (A/B MAC), and
Durable Medical Equipment Medicare Administrative Contractors (DME MAC) for
services provided to Medicare beneficiaries.


Password Changes for ALL Current J1 PPTN Users
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~EDI~General~Password%20Changes%20for%20ALL%20Current%20J1%20PPTN%20Users?opendocument

Password Changes for ALL Current PPTN Users - Beginning January 5, 2009,
all Professional Provider Telecommunication Network (PPTN) users will be
required to reset their Clerk ID password and then update it every 30 days.
Palmetto GBA has created a step-by-step instruction guide to help you
navigate the new PPTN screens. Please see notice linked below for more
details.


Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 15.0,
Effective January 1, 2009
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~MLNs~General~Quarterly%20Update%20to%20Correct%20Coding%20Initiative%20(CCI)%20Edits,%20Version%2015.0,%20Effective%20January%201,%202009?opendocument

MLN article 6290, Quarterly Update to Correct Coding Initiative (CCI)
Edits, Version 15.0, Effective January 1, 2009, applies to physicians
submitting claims to Medicare Carriers and/or Part A/B Medicare
Administrative Contractors (A/B MACs) for services provided to Medicare
beneficiaries.


Streamlining J1 Part B LCDs
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~Articles~General~Streamlining%20J1%20Part%20B%20LCDs?opendocument

This article is to notify J1 Part B providers that the Palmetto Team plans
to streamline the Part B LCDs on February 26, 2009, by implementing a
single set of J1 LCDs, with a single LCD Database ID Number, that will
apply to all Part B providers in J1.