Peach State Health Plan Blog

August 12, 2010

Dear Peach State Providers:

This letter serves as notice that effective September 12, 2010, Peach State Health Plan (Peach State) will begin requiring the inclusion of the National Drug Code (NDC) numbers on claim forms for all injectable drugs administered in the office or an outpatient setting.  This requirement is consistent with Georgia Medicaid requirements, which states that providers are required to bill/report injectable drugs administered in offices and outpatient facilities using the manufacturer’s 11-digit NDC numbers. Claims for injectable drugs received for processing without the NDC numbers and/or corresponding HCPCS/CPT codes or with invalid numbers will be denied.

The 11-digit NDC number located on the drug vial that is used must be printed on the paper CMS 1500 form in field 24A above the date-of-service (DOS) or in field 44 if billing on the UB-04 form. The N4 qualifier preceding the NDC number is required for paper and electronic claim transactions, 837 (X12N). Failure to include the NDC code when submitting claims for injectable drugs will result in a claim denial.

Claim Examples of the CMS 1500 and UB-04 Forms below:

CMS 1500 Claim Form with required NDC for injectable drug – POS 11 (click image to enlarge)

 CMS UB-04 Claim Form with required NDC for injectable drug – POS 22 (click image to enlarge)

If you have any questions about this notice, please contact Provider Services at 1-866-874-0633. Thank you for your continued participation with Peach State.

Sincerely,

Peach State Health Plan

This entry is filed under Blog, News.

Dear Peach State Provider:

Effective November 3, 2010, Peach State Health Plan (Peach State) will implement a new payment policy to facilitate the payment of Labor Checks.  A Labor Check is defined as evaluation of the fetal heart rate in labor using some form of fetal monitoring.

 If the service is billed with one of the following ICD-9 Diagnosis Codes:

6441, 64410, 64413, 6440, 64400, 64403, 6442, 64420, 64421, 642, 6420, 64200, 64201, 64202, 64203, 64204, 6421, 64210, 64211, 64212, 64213, 64214, 6422, 64220, 64221, 64222, 64223, 64224, 6423, 64230, 64231, 64232, 64234, 6424, 64240, 64241, 64242, 64243, 64244, 6425, 64250, 64251, 64252, 64253, 64254, 6426, 64260, 64261, 64262, 64263, 64264, 6427, 64270, 64271, 64272, 64273, 64274, 6429, 64290, 64291, 64292, 64293, 64294, 641, 6410, 64100, 64101, 64103, 6411, 64110, 64111, 64113, 6412, 64120, 64121, 64123, 6413, 64130, 64131, 64133, 6418, 64180, 64181, 64183, 6419, 64190, 64191, 64193, 643, 6430, 64300, 64301, 64303, 6431, 64310, 64311, 64313, 6432, 64320, 64321, 64323, 6438, 64380, 64381, 64383, 6439, 64390, 64391 and 64393;

With one of the following Revenue Codes: 760, 761, 762, 769, 720, 721, 724, 729 and 450; And either Place of Service 23 (Emergency Room) or Place of Service 22 (Outpatient hospital).

Peach State will reimburse the Labor Check at a fixed encounter rate of $150.00 provided that proper prior notification has been given to Peach State.

Please contact your Provider Relations Representative at 1-866-874-0633 if you have questions regarding the notice.

Sincerely,

Kevin B. Sears

Vice President, Network Development

This entry is filed under Blog, News.

Dear Provider:

As you know, Peach State Health Plan (Peach State) has partnered with National Imaging Associates, Inc. (NIA) to implement a radiology benefit management program. The high-tech radiology management program is on schedule to begin on August 2, 2010 for the following non-emergent outpatient radiology procedures:
• CT / CTA
• MRI / MRA
• PET Scan

Effective August 2, 2010, providers should contact NIA to obtain authorization for the services referenced above.

Peach State and the Georgia OB/GYN Association continue to work in partnership to address questions submitted by the Association’s member OB/GYNs regarding the implementation of the antepartum testing review program. Therefore, the implementation of the OB Ultrasound program will be delayed pending further communication from the health plan.

We appreciate your continued support and look forward to your assistance in assuring that Peach State members receive clinically appropriate advanced diagnostic imaging services. Should you have questions at this time, please contact your Provider Relations representative at 866-874-0633.

Sincerely,

Peach State Health Plan

This entry is filed under Blog, News.

Dear Peach State Provider:

Peach State Health Plan (Peach State) and the Georgia OB/GYN Association are working collaboratively in partnership to address the questions and concerns raised by the Association’s member OB/GYNs regarding Peach State’s proposed antepartum testing review program to be implemented by NIA. Our organizations will be meeting jointly on July 21st to discuss all outstanding issues. We are committed to working together to solve these issues in a mutually beneficial manner. As a first step, effective immediately, Peach State has agreed to no longer require “privileging” in order for Obstetricians to perform office based ultrasounds. All obstetricians who have already submitted an application will be automatically considered to have passed the privileging process. If you have not yet returned the application, you are not required to do so. Peach State and the Georgia OB/GYN society will work diligently to come to consensus on the details of the antepartum review program going forward, and we will update you when there are further details for distribution.

Thank you for your forbearance as we work through this process together.

Sincerely,

Peach State Health Plan

This entry is filed under Blog, News.

Dear Peach State Provider:

The Advisory Committee on Immunization Practices (ACIP) now recommends the use of the quadrivalent HPV vaccine, Gardasil, for males, ages 9 to 21 years. Based on the ACIP recommendation and effective immediately, Peach State Health Plan will accept CPT code 90649 for females AND males, ages 9 to 21 years enrolled in the Georgia Medicaid and Peach Care for Kids programs.  

The HPV vaccine will be supplied through the Vaccines for Children Program for males, ages 9 to 18 years, 11 months. The vaccine reimbursement is $8.00 for ages 9 to 18 years, 11 months. Males, ages 19 to 21 will be reimbursed according to the rate contained in your Peach State contract.

Providers should submit claims using the following billing guidelines:

If you have any questions about this communication, please contact Peach State Provider Services at 1-866-874-0633. We will be happy to assist you.

 Thank you.

Peach State Health Plan

This entry is filed under Blog, News.