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<p class=MsoNormal><b><u><font size=3 face=Arial><span style='font-size:12.0pt;
font-family:Arial;font-weight:bold'>ATTENTION: All Hospitals Billing for
Outpatient Drugs<o:p></o:p></span></font></u></b></p>
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12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>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.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>This message serves as a reminder for Maine Hospitals to
begin submitting this information via a Roster file method. <u>Roster
billing files for 3<sup>rd</sup> quarter (07/01/08 – 09-30-08) should be
submitted to the State no later than December 31, 2008.</u>
Additionally, it is necessary to bill for drugs on the list of <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>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.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>To access the “top 20” list please refer to the
following link. This list may be subject to change annually. <a
href="http://www.cms.hhs.gov/DeficitReductionAct/40_PhysicianAdministeredDrugs.asp"
title="http://www.cms.hhs.gov/DeficitReductionAct/40_PhysicianAdministeredDrugs.asp">http://www.cms.hhs.gov/DeficitReductionAct/40_PhysicianAdministeredDrugs.asp</a><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>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.<o:p></o:p></span></font></p>
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font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><u><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>MaineCare will be ready to accept production rosters
beginning Monday, November 17.</span></font></u><font size=2 face=Arial><span
style='font-size:11.0pt;font-family:Arial'> 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.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'>We appreciate your cooperation, and your service to
MaineCare members.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><i><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial;font-style:italic'>This is a one-way communication.
Please do not respond to this message.</span></font></i><o:p></o:p></p>
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font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
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