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

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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
IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage106DateAugust 1, 2013MedicationGamunex 10% (immuneglobulin)Humira (adalimumab)Influenza vaccinesKineret (anakinra)Lovenox (enoxaparin)Miacalcin NS (calcitonin)Nascobal(cyanocobalamin)Neupogen 400 mcg(filgrastim)Neupogen 600 mcg(filgrastim)Pegasys (peginterferonAlfa-2a)Peranex HC (lidocaine/hydrocortisone)Correct Unitfor BillingMl (Each vial is 10ml)Each (kit contains2 syringes)Ml (Submit indecimal format; donot round)Ml (Submit indecimal format; donot round)Ml (Submit indecimal format; donot round)Ml (Submit indecimal format; donot round)Ml (Submit indecimal format; donot round)Ml (Submit indecimal format; donot round)Ml (Submit indecimal format; donot round)Each (kit contains4 syringes)QuantityVariesDays’SupplyVaries2 300.5 ml 1Varies; should bedivisible by 0.67Varies30Varies3.7 30Varies; claims 30should be divisibleby 2.3 mlVaries; claims 30should be divisibleby 1.6 mlVaries; claims 30should be divisibleby 0.5 ml1 28Each 1 VariesProair HFA (albuterol) Grams 8.5 grams 30Proventil HFA (albuterol) Grams 6.7 grams 30Rebif pack (interferonBeta-1a)Ml (Submit indecimal format; donot round)4.2 ml 30Rebif syringe (interferonBeta-1a)Ml (Submit indecimal format; donot round)6 ml 30Remicade (infliximab) Each 1 VariesRestasis (cyclosporine) Each 32/64 30Risperdal Consta(risperidone)Each 2 28
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