[Provider] Reminder for MaineCare Hospitals that bill for Outpatient Drugs

[Provider Notification]

ATTENTION:  All Hospitals Billing for Outpatient Drugs

 

The Deficit Reduction Act (DRA) of 2005 required State Medicaid agencies
to provide for the collection of National Drug Codes (NDC).  This
relates to all claims for certain physician-administered drugs and is
for the purpose of billing manufacturers for Medicaid drug rebates.
Specifically, this relates to outpatient claims submitted to MaineCare
by hospitals for certain outpatient drugs, the "top 20" list of most
commonly prescribed outpatient drugs.  This requirement went into effect
for services provided on or after July 1, 2008.

 

This message serves as a reminder for Maine Hospitals to begin
submitting this information via a Roster file method.  Roster billing
files for 3rd quarter (07/01/08 - 09-30-08) should be submitted to the
State no later than December 31, 2008.    Additionally, it is necessary
to bill for drugs on the list of 

Top-20 outpatient drugs at the CPT/HCPCS code level.  For each drug
billed to MaineCare on the Top-20 list, the UB claim form must contain a
separate charge showing the appropriate HCPCS code.

 

To access the "top 20" list please refer to the following link.  This
list may be subject to change annually.  
http://www.cms.hhs.gov/DeficitReductionAct/40_PhysicianAdministeredDrugs
.asp

 

Previously CMS issued a change request (5950) informing hospitals they
have made modifications that would allow the capture of drug rebate data
on Medicare-Medicaid crossover claims on the UB 04 billing form.
MaineCare cannot currently accommodate the UB 04 billing method.  Until
further notice, MaineCare is requesting hospitals to bill for the Top-20
drugs at the CPT/HCPCS code level on their Medicare/Medicaid claims and
to include NDC code data for these crossover claims on their quarterly
rosters.

 

MaineCare will be ready to accept production rosters beginning Monday,
November 17.  In subsequent quarters, hospitals may submit rosters at
any point in the quarter.  Roster billing instructions are attached.  To
request your hospital's login name and password please call
1-800-321-5557, option 9.  For all other inquires please contact
1-800-321-5557, option 8.

 

We appreciate your cooperation, and your service to MaineCare members.

 

 

This is a one-way communication.  Please do not respond to this message.

 

 

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