PHARMACY

IMPORTANT INFORMATION ON NEW SPECIALTY PHARMACY PROVIDER EFFECTIVE 02/01/2012 - Ascend® Specialty Pharmacy

• Prescriber letter - 01/04/2012
• Patient Letter - 01/04/2012
• FAQ

12/22/11: IMPORTANT INFORMATION ABOUT NCPDP D.0 TESTING. PLEASE REVIEW THE FOLLOWING MATERIAL:

• Notice: Working with MedMetrics to test NCPDP D.0 transactions.
• Process for correct setup for D.0 secondary claims.
• NCPDP D.0 Payer sheet
• Test file format

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Provider Pricing Appeal Form

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January 2012 Part D Plan Information and Claims Processing Changes

• 11/8/11:  Pharmacies enrolled in Medicaid, VHAP, VPHARM and other publicly funded beneft pharmacy programs (sorted by the state then by city)

• July 11, 2011 PDL Changes - Limitation on Over-The-Counter (OTC) medications and clinical critera for use of low dose quetiapine (Seroquel^®)

• AWP Litigiation
• Bulletins & Advisories
• Coverage & Billing Issues
  (Medmetrics Health Partners)
• Drug Coverage Lists (New information as of 7/1/11) Includes information on multi-ingredient compounds, new OTC coverage rules, and drugs requiring 90-day refills.
• Drug Utilization Review Board 
• FDA Alerts
• MAC List
• MedWatch Form
• Part C & D Resources
• Pharmacy Assessment
• Pharmacy Benefits Management
• Preferred Drug List & Criteria
• Prior Authorization Request and Order Forms
• Prior Authorization Review Process 
• Program Coverage
• Provider Manual (updated 1/1/12)
• Reports
• Tamper-Resistant Drug Pads
• Unique IDs to replace Social Security numbers for claims and ID cards (effective October 1, 2010)

• Beneficiary Bill of Rights
• Banners, Alerts & Advisories
• Claims Processing  (Transaction Services Login)
• Covered Services Chart - July 1, 2011 (1/6/12)
• CPT Codes/Fee Schedules
• HP Enterprise Services Information
• Forms 
• HIPAA Tools
• Medicaid /DVHA Rules
• Medicaid State Plan
• Methodology for DSH FFY2012
• Provider Manuals
• Provider Lists
• Software

CLINICAL INITIATIVES
Blueprint for Health

• VT Buprenorphine Practice Guidelines

Chronic Care Initiative

• Description and Information
• Healthy Living Action Plan
• Current Activities
• VCCI Member Brochure
• APS Healthcare 

Developmental Screening for Young Children

Diabetes Clinical Practice Guidelines

Prescription Drug Abuse & Urine Drug Screens

• Summary of Initiatives

CLINICAL RESOURCES

• Aid Category Code Lists
• Clinical Utilization Review Board
• Drug Utilization Review Board
• Prior Authorization, Tools & Coverage Guidelines

DENTAL

• CDT Codes/Fee Schedule
• Claims Processing/ Transaction Services
• Dental Dozen Brochure
• HIPAA Tools
• Manuals -Dental Supplement
• General Assistance Guidelines for Emergency Dental Treatment
• Prior Authorization Forms

TRANSPORTATION

• Non-Emergency Medical Transportation (NEMT) Manual (04/04/11)
• In-State, Out-of-Area/Out-of-State Medicaid Transportation Physician Referral Form

HEALTH CARE PRICE & QUALITY TRANSPARENCY RULE

• Act 53 and HRAP
• Vermont Hospital Report Cards

PROGRAM INTEGRITY Report Medicaid Fraud, Waste & Abuse

• General Information
• Fraud, Abuse & Team Care Referral Form (3/17/11)
• Contact Information
• Team Care Program Information (3/17/11)
• Medicaid Integrity Program Audit Announcement & Information