Prescribed Drugs Provider Manual - Iowa Department of Human ...

IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage101DateAugust 1, 2013FIELD NAME/DESCRIPTIONINSTRUCTIONS44 – PA TYPE CONDITIONAL. Enter code “2” if a number wasentered in the “PRIOR AUTH # SUBMITTED” box.Otherwise, leave blank.45 – OTHER COVERAGE CODE CONDITIONAL. To determine whether the memberhas drug coverage under other insurance, checkthe member’s eligibility using the EligibilityVerification System (ELVS) or the IME web portal.♦♦♦♦If a member has Iowa Medicaid pharmacyinsurance only and no other primary insurance,leave this field blank or enter a zero.Enter code “1” if the member states there is noother insurance but the claim has already beenrejected with a reject code of 41 “Submit toPrimary Payer.” Iowa Medicaid’s eligibility fileconflicts with the primary third-party insurancecompany’s information.Enter code “3” if other coverage does exist andthe drug is not covered under the primaryinsurance plan. NOTE: Also allowed for PartD excluded drugs.Enter code “8” when billing is for patientfinancial responsibility.46 – DELAY REASON NOT USED.47 – LEVEL OF SERVICE NOT USED.48 – PLACE OF SERVICE OPTIONAL.CLINICAL49 – DIAGNOSIS CODE NOT USED.Only the indicator “06 = Patient Pay Amount”will be accepted as an other payer-patientresponsibility amount qualifier.50 – DIAGNOSIS CODEQUALIFIERNOT USED.