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To: IPA Members From: Heather Rodgers 8/1/06
1. HUMANA PRICING ISSUES · Recently we have been informed that Humana is reimbursing claims at the generic rate on NITRO-DUR patches. According to Humana, they identify this product as a generic; therefore Humana cannot remove this product from their drug list without CMS approval. They are developing a work-around to correct the problem. This should be going into effect the first part of August 2006. Humana will be backdating the fix so that claims filled incorrectly can be reversed and resubmitted.
· Humana also notified us that the MAC pricing on Cortic ND would be reviewed at the next MAC Steering Committee meeting on August 10, 2006. Any adjustments made to MAC for this product would be backdated so these claims could be reversed and resubmitted (with the original date of service) for higher reimbursement. We will notify you as soon as we get any new information. 2. MEDCO MAC INCREASE The MAC on Triamcinalone 0.1% Dental Paste has been increased to $4.001/per gram effective 7/27/06. 3. DON’T FORGET TO GET YOUR NPI NUMBER! You can apply online for a NPI number by visiting https://nppes.cms.hhs.gov and select Health Care Provider or by calling 1-800-465-3203 to request a paper application. Remember getting an NPI number is free – not having one can be costly! If you have any questions, comments or third party issues please list them below and fax to Heather Rodgers at 609‑395‑1007.
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