Newsletter Vol. 10, No. 79

REQUIREMENTS: - By March 1, 2001: Medicaid providers must implement Medicare-covered drug initiative procedures outlined in this policy. PAAD providers must implement effective September 1, 2000. - Billing team must verify Medicare enrollment status for PAAD claims; PAAD providers without Medicare enrollment following the grace period cannot dispense PAAD prescriptions. - For Medicaid claims: Configure billing system to accept Medicare assignment for Medicare-covered drugs, process Medicare claims through normal channels, and automatically crossover denied Medicare claims to Medicaid as medical supply claims. Pharmacy staff must submit denied claims to Medicaid using HCFA-1500 form. - For PAAD claims: Configure system to prevent POS processing for Medicare-covered drugs only. Allow all PAAD-covered drugs to process through POS. Implement recoupment procedures when Medicare payments are processed by DHSS. - All pharmacy staff must follow Medicare claim documentation requirements for both Medicaid and PAAD Medicare-covered drug claims. - Ensure PAAD beneficiary co-payments are limited to $5.00; Medicaid beneficiaries cannot be charged. - Reference prior guidance in Medicaid Newsletters Vol. 10 No. 54 (July 2000) and Vol. 10 No. 65 (September 2000) for Third Party Liability procedures. Coordinate implementation with those initiatives.