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

IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage105DateAugust 1, 2013F. EDITS AND SPECIAL BILLING INFORMATION1. Claims for Deceased MembersSubmit claims for all Iowa Medicaid members using the dispensing date.Pharmacy claims must be billed before a member’s date of death for claimsprocessing. Failure to bill before the date of death may result in claimrecoupment for any claims processed after that date of death.2. Common Billing ErrorsMedications can often be described using three measures: each, grams, andmilliliters. It is important to choose the correct unit of measure when billing.MedicationBactroban cream(mupirocin)Bactroban ointment(mupirocin)Byetta 5 mcg(exenatide)Byetta 10 mcg(exenatide)Correct Unitfor BillingGramsGramsMl (Submit indecimal format; donot round)Ml (Submit indecimal format; donot round)Days’Quantity SupplyVaries; should be Variesdivisible by 15gramsVaries; should be Variesdivisible by 22grames1.2 ml 302.4 ml 30Copaxone (glatiramer) Each 1 30Diastat ACDL gelEach (kit contains1 Varies(diazepam)2 syringes; bill #of kits)Enbrel 25 mg Each 1 1Enbrel 25 mg/0.5 ml(etanercept)Enbrel SureClick(etanercept)Fragmin (dalteparin)Ml (Submit indecimal format; donot round)Ml (Submit indecimal format; donot round )Ml (Submit indecimal format; donot round)Varies claimsshould be divisibleby 0.5 mlVaries should bedivisible by .98 mlVaries3030Varies