Palmetto Government Benefits Administrators DMERC MEDICARE ... · Durable Medical Equipment...

Alabama GeorgiaArkansas KentuckyColorado LouisianaFlorida Mississippi

New Mexico South CarolinaNorth Carolina Tennessee

Oklahoma TexasPuerto Rico Virgin Islands

Palmetto Government Benefits Administrators

Durable Medical Equipment Regional Carrier P.O. Box 100141 Columbia, SC 29202-3141

ATTENTION PHYSICIANS AND SUPPLIERSIN THIS ISSUE:

SEPTEMBER 1994 ISSUE 8PAGE 94-177

Transition Update .................................................................... 94-177Electronic Data Interchange (EDI)

Added Benefit .................................................................. 94-178Grandfathering PEN Update ................................................... 94-179New Medical Director .............................................................. 94-179Audio Response Unit (ARU) For Claim Status ........................ 94-179Supplier Signature Requirements Reminder ........................... 94-179Telephone Service: New DMERC # (803) 691-4300 ............... 94-180Helpful Hints ..................................................................... 94-180-181Resubmittals vs. Reviews....................................................... 94-181Continuous Passive Motion (CPM) Device

Billing Instruction ............................................................. 94-182HCPCS Code A4200 Update .................................................. 94-182New Interest Rate Payable on Clean Claims .......................... 94-182Alternating Pressure Mattresses (E0277) Update ................... 94-182Electronic Data Interchange (EDI) Remittance

Advice Notices, Standard Reason Codes ....................... 94-182

Omnibus Budget Reconciliation Act of 1993 (OBRA 93)Supplemental Plans ................................................. 94-183-184

Transtracheal Catheters .......................................................... 94-184DMERC Medicare Advisory Update ........................................ 94-185Workshop Series Success ...................................................... 94-185HCFA Common Procedure Coding System (HCPCS)

Coding Help-Line: Commonly Asked Questions ...... 94-186-187Lymphedema Pumps/Pneumatic Compressors ...................... 94-188Questions & Answers ....................................................... 94-188-189Crossover Update ............................................................ 94-190-191Using the OCNA Matrix .................................................... 94-192-196Anti-Fraud Unit ................................................................. 94-197-199Recategorization of Orthotic Seating Systems ....................... 94-1991994 Durable Medical Equipment Fee Schedule

Update ..................................................................... 94-200-201Telephone Directory ................................................................ 94-202Glossary .................................................................................. 94-203

DMERCMEDICARE ADVISORY

TRANSITION UPDATE

July 1, 1994 marked the end of the Region C state-by-state transition to the Durable MedicalEquipment Regional Carrier (DMERC). Palmetto Government Benefits Administrators(Palmetto GBA) is currently servicing over 43,000 suppliers (according to the National SupplierClearinghouse September 7, 1994) across Region C and throughout the United States. Todate, Palmetto GBA has processed over 6,168,000 claims.

We appreciate the opportunity to continue to serve you.

178 September 1994 DMERC Medicare Advisory

ELECTRONIC DATAINTERCHANGE(EDI) ADDEDBENEFIT

Effective the beginning of July 1994, electronic billers now have an added benefit. As anelectronic biller you can have direct on-line systems access to the status of your claims filedwith Palmetto Government Benefits Administrators (Palmetto GBA).

Within days after you file an electronic claim, you will be able to determine the status of theclaim. For example, as early as three days after submitting your claims you will be able todetermine through a claims status inquiry screen, whether your claims are being reviewedor developed for further information. After your claims have been processed, you will be ableto use the claims status inquiry screens to determine the resolution of your claims (if theyhave been paid or denied). This feature also helps you to better anticipate your cash flowas you now have access to a checks issued screen called "PAYME". This screen offers thedollar amount of the three most recent days in which checks were issued to your suppliernumber.

If you are an electronic biller or are working with our EDI department to become one, youshould have received an electronically transmitted enrollment form for this new benefit, withyour July error reports.

Enrolling for the new benefit is easy. Simply print the enrollment form off of your system.Complete and mail this form to our EDI department, at the address that follows. Moredetailed instructions on how to complete the form and return it to EDI appear with theenrollment form in the error report. The only possible cost associated with this benefit is$15.00 for communication access to our system.

Within a few days of returning your completed enrollment form, you will receive an electronicnotice of your assigned security clearance to our claims status inquiry screens and specificdocumentation on how to obtain critical claims processing information from the screens.

This added feature will allow you to look at the status of your claims in process and avoidmaking unnecessary and time-consuming telephone calls to Palmetto GBA to inquire aboutyour claims.

Access to these inquiry screens is available to electronic billers with security clearance:

Monday through Friday: 7:00 a.m. to 9:30 p.m. (Eastern Time)Saturday: 8:00 a.m. to 4:00 p.m. (Eastern Time)

If you have any questions or have not received your enrollment form, please contact our EDIdepartment directly.

Electronic Data Interchange: (803) 788-9751

Palmetto GBA/EDI, Medicare Region C DMERCP.O. Box 100145Columbia, SC 29202-3145

September 1994 DMERC Medicare Advisory Page 94-179

The following is an update to the PEN coverage revision which was published in the Juneissue of the DMERC Medicare Advisory on page 94-129. The June revision was anupdate to the Grandfathering Policy which was published in its entirety in the Januaryissue of the DMERC Medicare Advisory on pages 94-7-10. The following updatesupersedes any prepublished Grandfathering PEN information.

For parenteral nutrition, if it has been approved by the prior regional carrier, payment willbe continued by the DMERC. Payment under the grandfathering provision, scheduledto expire with dates of service on or after September 1, 1994, has been extended. PENsuppliers will be given a 45 day notice prior to the elimination of the grandfatheringprovision for parenteral nutrition.

GRANDFATHERINGPEN UPDATE

NEW MEDICALDIRECTOR

Dr. Robert Tallon, Region C Medical Director, resigned effective September 2, 1994.Recruiting is underway and you will be notified of the new Region C Medical Directorwhen our selection has been finalized. In the interim, Dr. Lyn Howard will serve in a part-time capacity as the Region C Medical Director. Dr. Howard has extensive credentialswith almost thirty years of experience as a practicing physician and has served aspresident of the American Board of Nutrition. We are fortunate to have Dr. Howard'sexpertise and guidance.

AUDIO RESPONSEUNIT (ARU) FORCLAIM STATUS

We encourage paper claim submitters to utilize our Audio Response Unit (ARU) to obtainclaim status. To access our ARU you may telephone your Dedicated Work Team, at (803)691-4300. Please refrain from checking the status of claims before 30 days have elapsedsince submission. Accessing the ARU may enable you to get answers to some of yourquestions without waiting to contact a dedicated work team associate. All that is neededto access the ARU is a touch-tone telephone, your National Supplier Clearinghouse(NSC) assigned supplier number, the beneficiary's Medicare number, and the date ofservice.

With a touch-tone telephone, you can:t Get the latest information on Medicare issues.t Receive on-line, detailed claims information regarding:

Amounts applied to the deductible Line item informationAmounts paid on a claim Claim denial informationAdjusted payment information Claim pending information

SUPPLIERSIGNATUREREQUIREMENTSREMINDER

The supplier or authorized representative must sign Item 25 of the HCFA-1500(12/90) form. The month, day and year the form was signed must also be provided.Typewritten signatures are not acceptable. The only valid substitutions for suppliersignatures are rubber stamp facsimiles and/or computer generated machine pre-pared facsimiles. Use of any other type of supplier signature will result in unnecessarydelays in claims processing.


Effective October 1, 1994, toll-free telephone service for all DMERCs will bediscontinued. During transition, toll-free telephone service has been provided andfunded to assist suppliers in the transfer from doing DMEPOS business with their localcarrier to doing business with the DMERCs. Now that the transition has successfullyconcluded, toll-free telephone service can no longer be made available. To reachPalmetto GBA, you may continue to call your Dedicated Work Team as outlined inSection 21 of the DMEPOS Supplier Manual until October 1, 1994. Effective October1, 1994, you should begin using our new toll number, (803) 691-4300. When callingthis number you will be automatically routed to the appropriate team by electronicidentification of the area code from which you are calling.

To assist the dedicated work team associates in responding to your calls as quicklyas possible, please be sure to consult your Region C DMEPOS Supplier Manual andissues of the DMERC Medicare Advisory for an answer to your question beforecalling. By doing this you may find the answer to your question is at your fingertips,eliminating your need to call.

Your dedicated work team associates realize that certain situations arise that requireyou to check into a beneficiary's history to avoid billing problems. However, it isextremely important for you to realize that Palmetto GBA is bound by federal laws thatpresently prohibit releasing certain information to you per the Privacy Act of 1974. Toassist in your billing, here are a few situations and related suggestions to help whenwe cannot give you the information you are requesting:

1. Certification dates for equipment:a) If you are billing for the equipment, this information must already be in your

files prior to billing.b) If you are planning to supply a beneficiary with equipment and you want to

know if the item has been previously certified:- Ask the beneficiary, family member, or acting representative.- Contact the beneficiary's physician prescribing the equipment.- Check with previous supplier if possible or applicable.

2. Validate Medicare eligibility and numbers:a) The beneficiary's valid Medicare number should be the one on his/her

Medicare card.b) The effective dates on the card indicate the start date of the beneficiary's

eligibility to Medicare.c) Any changes in a beneficiary's Medicare number would result in a new card

being issued by the Social Security Administration.

3. Dates of birth/death:a) Ask beneficiary, family member, acting representative, physician, etc.

4. Deductible:a) If you file assigned claims, your remittance will indicate if any portion of the

claim was applied toward the patient's deductible.b) Ask the beneficiary, family member, or acting representative.

TELEPHONESERVICE:NEW DMERCNUMBER(803) 691-4300

t We ask that you refrain from using highlighter on the paper copies of the HCFA-1500 (12/90) form and the Certificates of Medical Necessity (CMNs) submitted tothe DMERC. In processing, highlighted areas on imaged documents appearblack on our computer screen, creating the potential to block out vital claimprocessing information. Specific areas for physician completion may be indicatedwith symbols, i.e., asterisks.

t If a beneficiary has a Medigap supplemental policy, be sure that this informationappears in Item 9 of the HCFA-1500 (12/90) form. HCFA-1500 (12/90) forminstructions begin on page 1.17 in your DMEPOS Supplier Manual.

t All HCFA-1500 (12/90) forms should include the ordering physician's name inItem 17 and his/her Unique Physician Identification Number (UPIN) in Item 17a.A claim submitted to Palmetto GBA without a UPIN will result in a denial.

t When ordering HCFA-1500 (12/90) claim forms, specify forms which are pre-printed in red dropout ink. Red ink can be clearly imaged and is easily read. Othercolors, such as green or blue, are more difficult to reproduce and are not alwayslegible when viewed by your teams.

HELPFUL HINTS


HELPFUL HINTS(Cont'd)

t Remember that Palmetto GBA also produces beneficiary brochures that helpexplain the regionalization of Durable Medical Equipment, Prosthetics, Orthoticsand Supplies (DMEPOS) claims to beneficiaries. Ask a dedicated work teamassociate, and they will arrange to have these publications mailed to you.

t Submit a copy of the current CMN with each first claim for grandfathered patientsreceiving immunosuppressive drugs. Prescription information contained on theCMN is vital to the accurate processing of claims.

t When billing large quantities of surgical dressings, refer to page 94-115 of theJune 1994 issue of the DMERC Medicare Advisory for assessment of the clinicalinformation that is needed to justify unusual volumes. To expedite processing ofthese claims this clinical information should be submitted with each claim toestablish the medical necessity.

RESUBMITTALS VS. REVIEWS

NOTE: When requesting a hearing, your request must be submitted in writing to, Palmetto Government BenefitsAdministrators, Hearings Department, Medicare Region C DMERC, P.O. Box 100236, Columbia, SC29202-3236. Hearing requests sent to any other address may be delayed.

Claims should be resubmitted (refiled) if:

t The original claim was totally denied, (i.e., no pay-ment was issued) due to an error on the part of thebiller, which can be corrected. Errors on the part ofthe biller which could be corrected include such itemsas the wrong HCFA Common Procedure CodingSystem (HCPCS) code, date of service, or incorrectHealth Insurance Claim (HIC) number.

ort The original claim was totally denied, (i.e., no pay-

ment was issued) due to missing or incompleteinformation and the appropriate or corrected informa-tion can be resubmitted with the claim.

Action to be taken:

Resubmitted claims may be transmitted electronically,with any needed additional documentation indicated inthe HAØ record. Resubmitted paper claims shouldinclude only the HCFA-1500 (12/90) form and any docu-mentation that supports the need for the service(s) oritem(s).

Resubmitted claims should not include copies of remit-tance notices or any other information which would not besubmitted with an original claim. Cover letters, for ex-ample, will cause unnecessary processing delays.

Claims may be reviewed if:

t The original assigned claim was denied forlack of medical necessity.

ort The original assigned claim was denied and

disposition is not satisfactory to the supplier.

or

t The original assigned claim was partially paidand the supplier is not satisfied with thedisposition.

Action to be taken:

Reviews may be conducted over the telephone bycontacting your Dedicated Work Team, at (803) 691-4300. All pertinent information should be gatheredand available for discussion at the time the telephonecall is placed to the Dedicated Work Team.

Review requests submitted in writing may require 45days for completion and should include the claim inquestion, the remittance notice and any additionalinformation that is to be considered.


In following national policy coverage for the Continuous Passive Motion (CPM)device, (HCPCS E0935), are covered for patients who have received a total kneereplacement (ICD-9 V43.6). To qualify for coverage, use of the device mustcommence within two days following surgery. In addition, coverage is limited to thatportion of the three week period (21 days) following surgery during which the deviceis used in the patient's home. The date of surgery should be indicated on all HCFA-1500 (12/90) claim forms. For paper claim forms the date of surgery should befurnished in Item 19 and for electronically submitted claims in the HAØ record.

The fee schedule for HCPCS code E0935 has been converted to a per diem feeschedule and is listed below.

CONTINUOUSPASSIVE MOTION(CPM) DEVICEBILLINGINSTRUCTION

HCPCS CODE A4200UPDATE

The recently expanded coverage policy for surgical dressings includes many newHCPCS codes and eliminates pricing modifiers. HCPCS code A4200 was replacedwith the following three codes. Begin using these three codes immediately in placeof HCPCS code A4200 for claim submission, including claims for gauze supplied toostomy patients.

K0216 Gauze, non-impregnated, pad size 16 sq. in. or less, without adhesive border, eachdressing

K0217 Gauze, non-impregnated, pad size more than 16 sq. in. but less than or equal to 48sq. in., without adhesive border, each dressing

K0218 Gauze, non-impregnated, pad size more than 48 sq. in., without adhesive border,each dressing

Any claim with HCPCS code A4200 (regardless of the type of claim, i.e., surgicaldressing and/or ostomy) received on or after October 1, 1994 will be denied.

NEW INTEREST RATEPAYABLE ON CLEANCLAIMS

The Treasury Department has announced that the Prompt Payment interest rate willchange to 7.0 percent effective for scheduled Medicare payment dates of July 1through December 31, 1994. This is a large increase over the 5.5 percent rate paidfor January 1 through June 30, 1994. The new rate has been approved by theSecretary of the Treasury and was published in the Federal Register the week of June28, 1994.

ALTERNATINGPRESSUREMATTRESSES (E0277)UPDATE

Effective with newly furnished alternating pressure mattresses (code E0277), Pal-metto GBA needs a completed CMN (DMERC CMN 01.01) in order to accuratelyprocess claims for this item. Questions 12, 13 and 21 on the CMN must be completed(if applicable). Claims received for this item issued to new patients may be delayedor denied if submitted without CMN 01.01.

ELECTRONIC DATAINTERCHANGE (EDI)REMITTANCE ADVICENOTICES, STANDARDREASON CODES

Effective October 1, 1994, new standard reason codes will replace existing codes onall electronic remittance advice notices.

The standard reason codes were developed by the American National StandardsInstitute (ANSI) Accredited Standards Committee. The new codes are extensive andare a combination of alphanumeric and numeric codes, some containing decimals.Most codes are four digit codes.

We are in the process of creating a crosswalk from the current codes to the new codes.We anticipate sending this crosswalk information to all providers and vendors that arecurrently receiving remittances electronically. In 1995, the standard reason codelanguage will be expanded to include hardcopy remittances advices. We will issuea separate notification of the codes at that time.

REVISED 1994 DME FEE SCHEDULE

HCPCS AL AR CO FL GA KY LA MS NC NM OK SC PR TN TX VI

E0935 16.98 18.74 19.98 19.98 16.98 19.98 19.26 16.98 18.45 16.98 16.98 16.98 14.89 16.98 19.98 16.98


The Omnibus Budget Reconciliation Act of 1993 (OBRA 93) effective August 10,1993, provides that if a beneficiary is eligible for or entitled to Medicare based on End-Stage Renal Disease (ESRD), Medicare will be the Secondary Payer (MSP) duringthe first 18 months of ESRD-based eligibility or entitlement, or the portion of thatperiod occurring after August 9, 1993, even if the beneficiary is also entitled toMedicare based on age or disability. Under prior law, any group health plan, includinga retirement plan, was obligated to pay primary to Medicare during the first 18 monthsof ESRD-based eligibility or entitlement only when ESRD was the sole basis of thateligibility or entitlement. (The ESRD MSP provision was not linked to active employ-ment status. That aspect of the ESRD MSP provision did not change under OBRA 93.)The ESRD MSP provision now applies to dual eligibility/entitlement situations as well.Accordingly, even retirement plans that have been supplementing Medicare for manyyears are now subject to the ESRD MSP provision.

The law does not differentiate between plan types, nor does it provide specialprovisions applicable to health plans which purport to pay only for supplementalbenefits. All Group Health Plans (GHPs) which meet the GHP definition found at§5000(b)(1) of the Internal Revenue Code - regardless of the type of coverageprovided - are required to pay primary during the coordination period.

Effect of Dual Entitlement on Benefit Coordination

Paragraph 1 below pertains to coordination periods governed solely by prior law.Paragraph 2 deals with coordination periods which are partially governed by prior lawand partially governed by present law (as amended by OBRA 93). Paragraph 3 dealswith coordination periods governed solely by OBRA 93.

(1) Coordination Period Ended Before August 1993. If the first 18 months of ESRD-based eligibility or entitlement ended before August 1993, Medicare was primarypayer from the first month of dual eligibility/entitlement, irrespective of when dualeligibility/entitlement began.

Example:

Mr. A, who is covered by a group health plan, became entitled to Medicare on thebasis of ESRD in January 1992. On December 20, 1992, Mr. A attained age 65and became entitled on the basis of age. Medicare became the primary payerbecause of dual entitlement effective December 1992. Since the first 18 monthsof ESRD entitlement ended before August 1993 (June 1993), OBRA 93 has noaffect on Medicare’s status as the primary payer.

(2) First Month of ESRD Eligibility/Entitlement and First Month of Dual Eligibility/Entitlement Between March 1992 and August 1993.

(i) Medicare is primary payer from the first month of dual eligibility/entitlementthrough August 9, 1993;

(ii) Medicare is secondary payer from August 10, 1993 through the 18th monthof ESRD-based eligibility or entitlement; and

(iii) Medicare again becomes primary payer after the 18th month of ESRD-basedeligibility or entitlement.

Example:

Miss B, who has group health plan coverage, became entitled to Medicare on thebasis of ESRD in July 1992, and also became entitled on the basis of disabilityin June 1993. Medicare was primary payer from June 1993 through August 9,1993; secondary payer from August 10, 1993 through December 1993, the 18thmonth of ESRD-based entitlement; and again became primary payer beginningJanuary 1994.

OMNIBUS BUDGETRECONCILIATIONACT OF 1993(OBRA 93)SUPPLEMENTALPLANS


(3) ESRD Eligibility/Entitlement March 1992 or Later; First Month of Dual Eligibility/Entitlement After August 1993

(i) Medicare is secondary during the first 18 months of ESRD-based eligibility orentitlement; and

(ii) Medicare becomes primary after the 18th month of ESRD-based eligibility orentitlement.

Example:

Mr. C, who has group health plan coverage, is diagnosed as having ESRD. Hebegins a course of maintenance dialysis on January 27, 1993, and becomes entitledto Medicare on the basis of ESRD effective April 1, 1993. On September 27, 1993,Mr. C reaches age 65 (dual Medicare entitlement is effective September 1, 1993).Medicare is secondary throughout the first 18 months of ESRD-based entitlement,and becomes primary payer beginning October 1, 1994.

Mrs. D, who is retired and entitled to Medicare on the basis of age, is also coveredunder a group health retirement plan. Mrs. D is diagnosed as having ESRD, andbegins a course of maintenance dialysis on June 27, 1993. Effective September 1,1993, Mrs. D is eligible for Medicare on the basis of ESRD. Medicare, which wasprimary because Mrs. D’s group health plan coverage was not by virtue of currentemployment, becomes secondary payer from September 1, 1993 through February1995, the 18th month of ESRD eligibility. Medicare again becomes primarybeginning March 1995.

OBRA 93SUPPLEMENTALPLANS(Cont'd)

TRANSTRACHEALCATHETERSMedicare Coverageand Payment WhenUsed in the Deliveryof Home OxygenTherapy

The use of home oxygen equipment is covered under the Durable Medical Equipment(DME) benefit of the Medicare program. Catheters used in the administration oftranstracheal oxygen are also covered as DME supplies in those cases in which theyare medically necessary for the patient to receive home oxygen treatment.

Medicare’s payment rules for home use of oxygen are governed by sections 1834 (a)(5)and (9) of the Social Security Act. These sections require that Medicare pay for homeuse of stationary oxygen with a single monthly payment amount that includes theoxygen equipment and all necessary supplies. The law does not permit separatepayment for any additional items (such as masks, tubing, humidity jars, or transtrachealcatheters) used in furnishing oxygen to a patient. The monthly payment amount alreadyincludes an allowance for such devices. Therefore, for Medicare to pay a separateamount for such devices would result in duplicate payments since the price of theseitems has already been included in the base for the fee schedule payment amount forhome oxygen therapy.

Because the fee schedule amount for home oxygen includes an allowance for allnecessary supplies, suppliers are obligated, without additional payment, to providetranstracheal catheters (including replacements as often as medically necessary) toMedicare recipients when ordered by a physician for purposes of home oxygen. Whenthe attending physician specifies delivery through a transtracheal catheter in Item 5 ofthe HCFA-484 (as indicated in the MCM at §3312.A.10), the oxygen equipmentprovided by the supplier must conform fully to what has been prescribed in order to becovered.

Medicare participating doctors and suppliers have agreed to accept the Medicareapproved amount as total payment for covered services for oxygen therapy in the home.The same is true for nonparticipating doctors or suppliers who agree to take assignmentin a particular case. These doctors and suppliers are prohibited from charging Medicarerecipients a separate amount for the catheter in the administration of oxygen. They areallowed to charge only for the annual deductible that the recipient has not met, and forthe coinsurance, which is the remaining 20% of the approved amount.

NOTE: The transtracheal catheter should be billed with code ZZ010 for patient ownedoxygen equipment, and code ZZ011 for patients renting oxygen equipment.Separate payment for this item is made when the patient owns the oxygenequipment (ZZ010).

September 1994 DMERC Medicare Advisory 4-185

t Coverage Statement Correction: On page 94-137 of the DMERC Medicare Advi-sory, June 1994 issue, an incorrect "HCFA-1500 (12/90) form Coding/Billing Re-minder" was listed under Incontinence Appliances and Care Supplies. The onlycatheters covered for female patients are indwelling, intermittent and external cath-eters. (Intermittent and external catheters were omitted in error.)

t HCPCS Correction: On page 94-138 of the DMERC Medicare Advisory, June 1994issue, code E0575 appears in Capped Rental Items incorrectly. This code should onlybe in Frequently/Substantial Serviced on page 94-142 of the same issue.

t HCPCS Correction: On page 94-138 of the DMERC Medicare Advisory, June 1994issue, code K0007 (extra heavy-duty wheelchair), should be included in the CappedRental Item category.

t HCPCS Correction: On page 94-139 of the DMERC Medicare Advisory, June 1994issue, code L3999 appears as L399g. This should read L3999.

t Incorrect Company Name and Address Listing: On page 94-163 of the DMERCMedicare Advisory, June 1994, the following name and address were listed incorrectlyas follows: Summit Health Care Services, 204 Donohoe Road, Greensburg, PA15601. The correct name and address is as follows: Summit Health Services, Inc.,Rd. 12, Box 204, Greensburg, PA 15601.

t Verbiage Correction: On page 94-165 of the DMERC Medicare Advisory, June 1994issue in the Pricing and DMEPOS Claim Payment Methodologies article, the sectionon Average Wholesale Prices erroneously included a note on oral anticancer drugs.The fourth bulleted item in that article should read as follows; “For immunotherapydrugs, an administration allowance of $5.00 is included in the drug allowance andshould not be billed separately with code Q0132. The administration allowance of$5.00 applies to bronchodilator drugs effective for sources provided on or after January1, 1994 and should be billed with code Q0132. (Prior to this the allowance was $3.80.)”

t Incorrect HCPCS Description: On page 94-168 of the DMERC Medicare Advisory,June 1994 issue, code B4153 incorrectly included Vivonex T.E.N. (Total EnteralNutrition) as part of its description. Vivonex T.E.N. (Total Enteral Nutrition) is part ofcode XX058's description, which is correctly listed on page 94-169 of the sameDMERC Medicare Advisory.

t HCPCS Deletion: On page 94-170 of the DMERC Medicare Advisory, June 1994issue, code A4557 [lead wires (part of K0118)] is to be deleted from this listing.

DMERC MEDICAREADVISORY UPDATE

From March 28 through June 30, 1994, Palmetto Government Benefits Administrators(Palmetto GBA) conducted a second series of workshops throughout Region C. Thefirst series of workshops, from August to December of 1993, included a review of allthe specialties covered under the Palmetto GBA Medicare contract. At the suggestionof Series I attendees, our second workshop series separated the specialties to allowfor more detailed instruction. Our specialties workshops covered the following fourgroupings; 1) Oxygen/Durable Medical Equipment; 2) Vision Services; 3) Parenteraland Enteral Nutrition, Ostomy, Surgical Dressing, Incontinence, Tracheostomy Sup-plies and Immunosuppressive Drugs; and 4) Prosthetics and Orthotics.

We are pleased to report that this second series was well received, with more than10,000 of the Region C suppliers attending.

As we begin to plan for the third workshop series, we look forward to your input andencourage you to discuss your educational needs with your ombudsman. Prior to thisthird series of workshops Palmetto GBA will mail invitations and registration forms toall suppliers enrolled with the National Supplier Clearinghouse (NSC).

WORKSHOP SERIESSUCCESS


The Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC)operates the HCPCS Coding Help-Line which provides Durable Medical Equipment,Prosthetics, Orthotics and Supplies (DMEPOS) coding assistance to suppliers. Thecoding advice is developed in conjunction with the four DMERCs. The consensusopinion of the DMERCs on any given coding issue will be given to the suppliers.

Please have your supplier number available when you call the HCPCS Coding Help-Line. This information will allow the telephone representatives to immediately beginresearching your coding question. Your supplier number is needed to log your call anddocument your question. (Commonly asked questions and their answers arepublished in the DMERC Medicare Advisory for all to benefit.)

If you require coding assistance on numerous products or items, please send thisinformation in writing. By writing your questions/concerns, you can save yourself atelephone call and have written documentation of the response. Coding questioncorrespondence should be addressed to:

SADMERC/HCPCS UnitPalmetto Government Benefits AdministratorsP.O. Box 100143Columbia, SC 29202-3143

HCPCS Coding Help-Line: (803) 736-6809Monday through Friday: 9:00 a.m. to 12:00 p.m. and

1:00 p.m. to 4:00 p.m. (Eastern Time)

The majority of the calls are received during the hours of 11:00 a.m. to 12:00 p.m. and1:00 p.m. to 3:00 p.m.. If you are having difficulty reaching a HCPCS Coding Help-Line representative, you may wish to try your call during other less busy times.

NOTE: The HCPCS Coding Help-Line representatives are unable to answer cover-age or pricing inquiries.

The following questions are those most commonly asked by suppliers when callingthe HCPCS Coding Help-Line.

Q 1) What is the correct code for Vivonex TEN?A XX058

Q 2) What is the correct code for Glucerna?A XX033

Q 3) What is the correct code for Promote?A B4150

Q 4) What is the correct code for an arm sling?A A4565

Q 5) What is the correct code for a Continuous Passive Motion (CPM) Device?A E0935

Q 6) What is the correct code for a cervical pillow?A E0943

Q 7) What is the correct code for disposable underpads, adult undergarments,A adult diapers?

A4554

Q 8) What is the correct code for a portable whirlpool?A E1300

Q 9) What is the correct code for Atrovent inhalation solution?A J7699 w/description and dosage.

HCFA COMMONPROCEDURECODING SYSTEM(HCPCS) CODINGHELP-LINE:Commonly AskedQuestions


Q 10) What is the correct code for a Continuous Positive Airway Pressure (CPAP)mask?

A K0183

Q 11) What is the correct code for an abdominal surgical support/elastic with rigidback panel?

A L0515

Q 12) What is the correct code for an ankle aircast?A L4350

Q 13) What is the correct code for an elastic compression stocking?A L8220 (Refer to range of L8100 thru L8230 for complete "stocking" codes).

Q 14) What is the correct code for oral Etoposide 50 mg?A 00015-3091-45

Q 15) What is the correct code for an elevated toilet seat?A E0244

Q 16) What is the correct code for toilet rails?A E0243

Q 17) What is the correct code for Jevity?A B4150

Q 18) What is the correct code for an AFO (ankle-foot-orthosis) tibial fracture "CAM"Walker?

A L2112 - soft, custom fittedL2114 - semi-rigid, custom fitted

Q 19) What is the correct code for an ambulatory post-op surgical shoe?A L3260

Q 20) What is the correct code for a non-molded wrist splint with velcro straps?A L3908

Q 21) What is the correct code for Epoetin Alpha (EPO)?A Q9920 through Q9940; you must know the patient's last Hematocrit (HCT)

to correctly select the appropriate Q code.

Example:

Q9920 - Injection of EPO, per 1000 units, at patient hct of 20 or lessQ9933 - Injection of EPO, per 1000 units, at patient hct of 33

NOTE: The above information is for billing purposes and does not indicate orguarantee coverage of the noted items.

t Do not have Medicare beneficiaries call the Help-Line.

t Remind all staff that the oral chemotherapy drug codes are filed to the DMERCwith a National Drug Code (NDC) number.

HCFA COMMONPROCEDURECODING SYSTEM(HCPCS) CODINGHELP-LINE:Commonly AskedQuestions(Cont'd)

Help-Line Hints


LYMPHEDEMAPUMPS/PNEUMATICCOMPRESSORS

It has been brought to our attention that there is some confusion throughout thesupplier community as to which HCPCS code should be used to properly bill for thevarious lymphedema pumps available. The following grid is provided to offerclarification in this area.

Q A Providing answers to your questions/concernson an on-going basis.&

These questions were submitted to Palmetto GBA by Region C suppliers, and the answers are being published so thatall may benefit.

1. Q What are the coverage guidelines for home hydrotherapy (whirlpool) code E1310?

A Whirlpools must be non-portable. A whirlpool requires that:

a) Patients be homeboundb) Patients have a condition for which whirlpool baths can be expected to provide substantial therapeutic benefit

(to justify the cost)c) If patient is not homebound but has such a condition to warrant whirlpool bath therapy, payment is restricted

to providing cost reimbursement elsewhere, (i.e., outpatient physical therapy) but would not be billable to theDMERC.

d) Cost is restricted to cost of the whirlpool and does not include remodeling or installation expenses.

Whirlpool bath therapy follows national policies.

Manufacturer/Brand Name Model Name/# HCPCS Code

Bio Compressions Systems/Sequential Circulator 2000 E06513000 E06523001 E06523004 E0652

Huntleigh Flowplus (AC330) E0650Flowpress (AC300) E0651

Flowtron E0650Lymphatron E0651

Lymphatron Trio (AC350) E0652Jobst/Extremity Pump Clinical Model E0650

System 7000 E0650System 7500 (II) E0651

Kendall Home Rx (5550) E0651Lympha Press 103A E0651

103M E0652201A - Mini E0651

201-M E0652Talley/Hemaflow 2 Pump Intermittent E0650

Sequential E0651Talley/Multicom 100 E0650

200 E0650300 E0651

500 ('93 & '94 model) E0652*Multipulse 1000 E0652Wright Linear Pump II E0652

IV E0652Chattanooga PresSsion E0651

4320 E06504322 E0650

Advantage 2100 E0652

* Talley/Multicom model '92 or before = E0651


2. Q Are collagen implants covered by Medicare?A Yes. Collagen implants are the responsibility of the local carriers, not the DMERC.

3. Q If a patient has had a capped rental item for over five years and now they are asking for a replacement, can westart the capped rental period over again? Will we need a new DMERC CMN to be completed?

A If the item is medically necessary, another capped rental period may begin. You will need to send a new DMERCCMN and documentation explaining why a replacement is needed.

4. Q When are DMEPOS items billable to the DMERC for a patient in a hospice care program?A The only time DMEPOS items which are provided to a hospice patient are billable to the DMERC are when those

items/supplies have been provided to the patient for the treatment of a condition or illness which is not relatedto the patient's terminal illness. When hospice coverage is elected, the beneficiary waives all rights to MedicarePart B payments for services that are related to the treatment and management of his/her terminal illness duringany period his/her hospice benefit election is in force.

5. Q What should a supplier do if they receive claims payments incorrectly?A Contact the Dedicated Work Teams by calling (803) 691-4300 for assistance in resolving any overpayments.

6. Q If a patient has been renting a standard wheelchair and now the physician wants the individual to have anupgraded chair, can we start a new capped rental period?

A You must submit a new DMERC CMN indicating the medical necessity for the upgraded item, indicate the originalitem has been returned, and the DMERC will review the potential for a new capped rental period to begin.

7. Q If I have not been receiving my advisories but I do have a supplier number, how do I ensure future issues aresent to me?

A Call your dedicated work team associate (Refer to Section 21 of your DMEPOS Supplier Manual), to verify yoursupplier number and address in our system.

8. Q Is hydration therapy covered by the DMERCs?A No, the patient must be infusing nutritional therapy or medications via an infusion pump to be considered for

coverage.

9. Q Can I ask to have my previously paid claims adjusted if the fee schedule update published in this Advisoryresulted in an increased allowance?

A No, however, we have received permission from HCFA to make an exception for reagent strips, code A4253.All claims for reagent strips paid for dates of service January 1, 1994 to June 15, 1994 will be adjusted to paythe increased allowance for this item in states where the fee schedule update resulted in an increased allowance.

NOTE: These adjustments are being handled systematically. You do not need to contact us to request additionalmonies.

10. Q Do suppliers have to submit the drug name and concentration when using a miscellaneous HCPCS drug code,J7799 or J7699?

A Yes, when a supplier uses code J7799 or code J7699 they must submit the drug name and concentration on eachclaim.

11. Q If a supplier receives a remittance notice with action code 'BW,' indicating an invalid Health Insurance Claim (HIC)number, should the supplier resubmit the claim?

A Yes, the supplier should resubmit the claim after having validated the beneficiary's HIC number and name.

12. Q Is Leucovorin covered by the DMERC when used with an external infusing pump in the patient's home?A No, unless the patient's coverage has been grandfathered for Leucovorin. If physician documentation indicates

that Leucovorin is administered by infusion pump for greater than eight hours as part of a documented treatmentprotocol, then coverage will be considered on an individual medical necessity basis.


Palmetto Government Benefits Administrators (Palmetto GBA) has negotiated agree-ments with all state Medicaid agencies within Region C to provide for the automaticcrossover of claim information.

Your Medicare remittance will contain an indicator which will identify each Medicareclaim that Palmetto GBA has forwarded to a Medicaid fiscal agent.

A Medigap policy meets the statutory definition of a "Medicare supplemental policy"contained in Section 1882(g)(1) of Title XVIII of the Social Security Act. It is a healthinsurance policy or other health benefit plan offered by a private entity to those personsentitled to Medicare benefits and is specifically designed to supplement Medicarebenefits. It fills in some of the "gaps" in Medicare coverage by providing payment forsome of the charges for which Medicare does not have responsibility due to theapplicability of deductibles, coinsurance amounts, or other limitations imposed byMedicare. It does not include limited benefit coverage available to Medicare benefi-ciaries such as "specified disease" or "hospital indemnity" coverage. Also, it explicitlyexcludes a policy or plan offered by an employer to employees or former employees,as well as that offered by a labor organization to members or former members.

The Medigap crossover process eliminates the need for beneficiaries or participatingproviders to file separate claims to Medigap insurers. Palmetto GBA will automaticallytransmit claim information to Medigap insurers when the beneficiary elects to assigntheir Medigap benefits to a participating provider.

Your Medicare remittance will contain an indicator which will identify each Medicareclaim that Palmetto GBA has forwarded to a Medigap insurer. To ensure that PalmettoGBA has the necessary information to effect this Medigap claim crossover, you shouldadhere to the claims filing instructions that follow.

For paper claims submission, the following information must be completed to ensureautomatic crossover claims to Medigap insurers. If this required information is missingor incomplete, no transfer of claim information will occur.

Item 9: Enter the last name, first name, and the middle initial of the enrollee in theMedigap policy, if it is different from that shown in Item 2 [of the HCFA-1500 (12/90) form]. Otherwise, enter the word SAME. If the Medigap benefits are notassigned, leave blank.

NOTE: Participating suppliers are to complete Item 9 and its subdivisions onlywhen the beneficiary wishes to assign his or her benefits under a Medigap policyto the participating supplier.

Item 9a: Enter the policy and/or group number of the Medigap enrolleepreceded by “MEDIGAP.”

Item 9b: Enter the Medigap enrollee’s birth date and sex.

Item 9c: Enter the claims processing address for the Medigap insurer.

NOTE: Leave Item 9c blank only if an Other Carrier Name and Address (OCNA)number, which is a carrier-assigned unique identifier of a Medigapinsurer, appears in Item 9d. For use of the OCNA number in Item 9d,please see page 94-191-195 of this DMERC Medicare Advisory.

Item 9d: Enter the Medigap insurer's OCNA number. Enter the name of theMedigap enrollee's insurance company only when it is not available onthe OCNA list.

Medigap Policies

MedicaidCROSSOVER UPDATE


CROSSOVER UPDATE(Cont'd)

Complementary/Supplemental Policies

For Electronic Media Claim (EMC) submission, the following information must becompleted to ensure automatic crossover claims to Medigap insurers. If this requiredinformation is missing or incomplete, no transfer of claim information will occur.

Data Field: DA0.04 Should contain an “I” to indicate Medigap, MSP orMedicaid

Data Field: DA0.06 Should contain “MG”Data Field: DA0.07 Should contain the first five positions of the OCNA

Number which is the other carrier-assigned uniqueidentifier found on pages 94-191-195

Data Field: DA0.08 Should contain the first five positions of the OCNANumber which is the other carrier-assigned uniqueidentifier found on pages 94-191-195

Data Field: DA0.18 Should contain the Medigap policy number

Use of the OCNA number will automate the crossover process for both paper copyand electronic claims. Please refer to pages 94-192-195 of this DMERC MedicareAdvisory for an updated OCNA list, to be used in Item 9d of the HCFA-1500 (12/90)form or for electronic claim submission use Data Field DA0.07 and DA0.08. Thisinformation updates the OCNA list provided in the Region C DMEPOS SupplierManual, Appendix E.

Non-Medigap Medicare Supplemental policies are Medicare supplement policies thatdo not meet the definition above of "Medigap" policies. Often these policies arereferred to as "Complementary Coverage" policies.

Medicare rules do not permit automatic crossover of the Non-Medigap MedicareSupplemental policy to the insuring organization. Rather, the Non-Medigap MedicareSupplemental insurer can voluntarily elect to enter into an agreement with PalmettoGBA for automatic crossover of Medicare claims information for their policyholders.

Do not list these Non-Medigap Medicare Supplemental policies under Item 9 of theHCFA-1500 (12/90) form. If we have an agreement with a Non-Medigap MedicareSupplemental insurer, Palmetto GBA will automatically forward the Medicare claiminformation to that insurer and indicate that we did so on your Medicare remittance.

Palmetto GBA is in the process of negotiating agreements with various insurers forautomatic crossover of claims. The most current list of these insurers is shown below.

Aetna Life and Casualty InsuranceAmerican General Life & AccidentAmerican Postal Workers UnionAmerican Republic InsuranceBCBS of AlabamaBCBS of ArkansasBCBS of FloridaBCBS of MichiganBCBS of North CarolinaBCBS of OklahomaBCBS of South Carolina

BCBS of New MexicoBCBS of TexasGovernment Employee

Hospital AssociationMutual of OmahaNational Association of Letter CarriersOlympic HealthPrudential (AARP)United American Insurance CompanyUnited States Automobile AssociationUSAble Life Insurance


The following matrix contains the Other Carrier Name and Address (OCNA) NumberList, alphabetized by the name of the Medigap Insurance Company. If multiple entriesare listed for the same Medigap Insurance Company, then a further match must be doneby address. If you cannot locate the correct Medigap Insurance Company name andassociated address, then you should write the complete name and address of theMedigap Insurance Company in Item 9c and 9d as outlined in the HCFA-1500 (12/90)form instructions or for electronic claim submission use Data Field DA0.07 and DA0.08.

USING THE OCNAMATRIX

A & H CLAIMS ............................................................60630A001AARP (PRUDENTIAL) ................................................18936A001ACADEMY LIFE INS CO ............................................30328A001ACORDIA BENEFITS .................................................92806A001ACORDIA LOCAL GOV’T SVCS ................................46250A001ACORDIA SENIOR BENEFITS ..................................46250A001ADMINISTRATIVE SRVS INC ...................................30345A001AFLAC ........................................................................31999A001 (AMER FAMILY LIFE ASSUR CO)AGRICULTURE INS ADMIN ......................................83501A001 AICI (ASSOC INS COS INC) ....................................46250A001AID ASSOC FOR LUTHERANS .................................54919A001AIG LIFE INS CO .......................................................19801A001AIROMD MAILHANDLERS INS .................................20855A001ALLIANCE HLTH BEN PLAN.....................................20065A001ALTA HLTH STRATEGIES ........................................21201A001AMALGAMATED LIFE & - 79 .....................................60607A001AMER ASSOC............................................................90712A001AMER BANKERS INS ................................................76101A001AMER BANKERS INS CO OF FL ..............................33157A001AMER COMBINED LIFE ............................................19047A001AMER COMMUNITY MUTUAL ..................................48152A001AMER EXCHANGE LIFE INS CO..............................75221A001AMER FAMILY MUTUAL INS CO ..............................53783A001AMER GENERAL LIFE & ACC ..................................37250A001AMER HARDWARE MUTUAL....................................55440A001AMER HOECHST PER ..............................................60558A001AMER INCOME LIFE INS ..........................................76702A001AMER INDEP LIFE INS CO .......................................19406A001AMER INS CO OF TX ................................................75266A001AMER INTEGRITY INS CO........................................19101A001AMER LIFE AND ACC................................................75221A002AMER LIFE INS CO ...................................................31999A001AMER NAT’L INS CO.................................................77553A001AMER PROGRESS L&HIC OF NY ............................10509A001AMER PROTECTIVE LIFE INS CO ...........................38732A001AMER REPUBLIC INS CO.........................................50301A001AMER SERVICE LIFE INS CO ..................................76107A001AMER STD LIFE & ACC CO ......................................73702A001AMER TRAVELLERS INS ..........................................18976A001 ATTN: MEDIGAP 1800 STREET ROAD WARRINGTON, PA 18976-250300AMER TRAVELLERS INS ..........................................19020A001 3220 TILLMAN DRIVE BENSALEM, PA 19020-202820AMERICARE INS .......................................................37215A002AMOCO CASUALTY & INDEM ..................................68102A001AMVETS INS PLANS .................................................43216A001APPALACHIAN LIFE INS CO ....................................25701A001ARMCO MED INS SVC CT ........................................43085A001ASSOC DOCTORS HLTH & LIFE..............................35289A001ASSOC INS COS INC (AICI) .....................................46250A001ASSOC MUT HOSP SRVC........................................35289A001ASSOCIATED LIFE INS CO ......................................46206A001ATCHISON TOPEKA ..................................................66612A001ATLANTIC AMER INS CO .........................................30319A001ATLANTIC AMER LIFE INS .......................................30319A002ATLANTIC AMER/BKRS FIDEL .................................30319A003ATLANTIC COAST INS CO .......................................30503A001ATLANTIC INS CO OF SA .........................................78714A001ATLANTIC & PACIFIC INS CO ..................................30359A001AUTO OWNERS LIFE INS CO ..................................48909A001AWARE GOLD............................................................55164A001BANKERS COMMER LIFE INS C..............................75240B001BANKERS FIDELITY LIFE INS ..................................30319A003

Company Name OCNA #

BANKERS LIFE & CASUALTY ..................................02888B001 BRUCE BALCOM 895 POST ROAD WARWICK, RI 02888-336195BANKERS LIFE & CASUALTY ..................................60630B001 4444 W. LAWRENCE AVE. CHICAGO, IL 60630-254644BANKERS MULTIPLE LINE .......................................75221B001BCBS MOUNTAIN STATE .........................................25325B001BCBS OF ALABAMA ..................................................35244B001BCBS OF ARIZONA ...................................................85069B001BCBS OF ARKANSAS ...............................................72203B001BCBS OF CALIFORNIA .............................................91365B001 ATTN: MEDIGAP UNIT PO BOX 4162 WOODLAND HLS, CA 91365-416262BCBS OF CALIFORNIA .............................................91470B001 P.O. BOX 7000 VAN NUYS, CA 91470BCBS OF CALIFORNIA .............................................94612B001 1950 FRANKLIN ST. OAKLAND, CA 94612-510350BCBS OF COLORADO ..............................................80203B001BCBS OF CONNECTICUT.........................................06473B001BCBS OF DELAWARE ...............................................19801B001BCBS OF FLORIDA ...................................................32202B001BCBS OF GEORGIA ..................................................31908B001BCBS OF ILLINOIS ....................................................60601B001BCBS OF IOWA .........................................................50309B001BCBS OF KANSAS ....................................................66629B001BCBS OF KANSAS CITY ...........................................64141B001BCBS OF KENTUCKY ...............................................40223B001BCBS OF LOUISIANA ................................................70898B001BCBS OF MAINE .......................................................04106B001BCBS OF MARYLAND ...............................................21117B001BCBS OF MASSACHUSETTS ...................................02171B001BCBS OF MEMPHIS ..................................................38101B001BCBS OF MICHIGAN.................................................48226B001BCBS OF MINNESOTA .............................................55164B001BCBS OF MISSISSIPPI .............................................39215B001BCBS OF MISSOURI .................................................63108B001BCBS OF MONTANA .................................................59604B001BCBS OF NATL CAPITAL AR ...................................20065B001BCBS OF NEBRASKA ...............................................68180B001BCBS OF NEVADA ....................................................89520B001BCBS OF NEW HAMPSHIRE ....................................03306B001BCBS OF NEW JERSEY ...........................................08206B001BCBS OF NEW MEXICO ...........................................87112B001BCBS OF NEW YORK (EMPIRE) ..............................10016B001BCBS OF NEW YORK (MURRAY HI .........................10156B001BCBS OF NEW YORK (CENTRAL) ...........................13221B001BCBS OF NEW YORK ...............................................14604B001BCBS OF NEW YORK (NE) .......................................12205B001BCBS OF NEW YORK (UTICA-WAT.........................13501B001BCBS OF NEW YORK (WESTERN) ..........................14240B001BCBS OF NORTH CAROLINA ...................................27702B001BCBS OF NORTH DAKOTA ......................................58121B001BCBS OF OHIO ..........................................................43697B001 P.O. BOX 943 TOLEDO, OH 43697-094343BCBS OF OHIO ..........................................................44115B001 ATTN: MEDIGAP UNIT 2060 E 9TH ST CLEVELAND, OH 44115-130460BCBS OF OKLAHOMA ..............................................74102B001

Company Name OCNA #


BCBS OF OREGON ................................................... 97207B001BCBS OF RHODE ISLAND........................................ 02903B001BCBS OF SOUTH CAROLINA ................................... 29219B001BCBS OF SOUTH DAKOTA ...................................... 57104B001BCBS OF TENNESSEE ............................................. 37402B001BCBS OF TEXAS ....................................................... 75080B001BCBS OF UTAH......................................................... 84130B001BCBS OF VERMONT ................................................. 05601B001BCBS OF VIRGINIA ................................................... 23230B001BCBS OF WISCONSIN .............................................. 53203B001BCBS OF WYOMING ................................................. 82003B001BD OF PENSIONS - PRESBY CH............................. 19101B001BELL UNIT .................................................................. 60690B001BENEFICIAL LIFE INS CO ........................................ 97207B002BENEFIT TRUST LIFE............................................... 63127B001BENEFIT TRUST LIFE INS CO ................................. 60045B001BLUE CROSS OF ARIZONA ..................................... 85002B001BLUE CROSS OF CALIFORNIA ................................ 93031B001BLUE CROSS OF IDAHO .......................................... 83707B001BLUE CROSS OF PA-INDEPENDEN........................ 19103B001BLUE CROSS OF PENNSYLVANIA .......................... 15242B001BLUE CROSS OF WASHINGTON............................. 98111B001BLUE SHIELD OF CALIFORNIA ............................... 94120B001 PO BOX 7168 SAN FRANCISCO, CA 94120-716868BLUE SHIELD OF CALIFORNIA ............................... 95667B001 SENIOR SERVICE CTR PO BOX 67-8010 PLACERVILLE, CA 95667-801010BLUE SHIELD OF IDAHO.......................................... 86501B001BLUE SHIELD OF KING COUNTY ............................ 98111B002BLUE SHIELD OF NORTH DAKOTA ........................ 58103B001BLUE SHIELD OF PENNSYLVANIA ......................... 17089B001BLUE SHIELD OF TENNESSEE ............................... 37212B001C M LIFE INS CO .......................................................06105C001CAL FARM BUR HLTH INS PRO ..............................95851C001CAREAMERICA LIFE INS CO ...................................91311C001CARLE CARE .............................................................61801C001CATHOLIC GOLDEN AGE INS .................................18505C001CELTIC LIFE INS CO.................................................60499C001CENTRAL BENEFITS MUTUAL I..............................43216C001CENTRAL MASSACHUSETTS HLTH .......................01608C001CENTRAL RESERVE LIFE INS .................................44136C001CENTRAL SECURITY LIFE INS ................................75083C001CENTRAL STATES HLTH & LIFE .............................60631C001CENTRAL STATES INS .............................................60017C001CENTRAL STATES OF OMAHA ...............................66134C001CERTIFIED LIFE INS CO ..........................................60630C001 ATTN: MEDIGAP UNIT 4800 N KENNETH AVE CHICAGO, IL 60630-252500CERTIFIED LIFE INS CO ..........................................75265C001 PO BOX 650209 DALLAS, TX 75265-020909CHRISTIAN FIDELITY LIFE.......................................75165C001CINCINNATI LIFE INS CO .........................................45250C001CITIZENS INS CO OF AMER ....................................78767C001CLINICIANS HLTH NETWORK ..................................93301C001CNA INS CO...............................................................30345C001 2302 PARKLAKE DRIVE ATLANTA, GA 30345-290202CNA INS CO...............................................................60630C002 4444 W LAWRENCE AVE CHICAGO, IL 60630CNA/CONTINENTAL CASUALTY CO .......................37230C001COASTAL STATES ....................................................73125C001COLONIAL..................................................................29306C001COLONIAL LIFE .........................................................29402C001COLONIAL PENN INS CO .........................................19181C001COLONIAL PENN LIFE INS .......................................29601C001COMBINED AMERICAN............................................60606C001COMBINED INS OF AMERICA ..................................19047C001COMBINED UNDERWRITERS LIF............................75710C001COMMERCIAL LIFE INS ............................................31401C001COMMONWEALTH INS CO ......................................43235C001COMMONWEALTH NATL LIFE IN ............................38732C001COMMUNITY MUTUAL INS .......................................45206C001

Company Name OCNA # Company Name OCNA #COMPANION HEALTH CARE ...................................29223C001COMPCARE HLTH SVCS INS CO ............................53202C001COMPLETE HEALTH.................................................35202C001CONFEDERATION LIFE INS CO ..............................29418C001CONSUMER UNITED INS CO...................................20063C001CONTINENTAL AMER LIFE ......................................19850C001CONTINENTAL ASSURANCE ...................................30326C001CONTINENTAL CASUALTY ......................................60604C001CONTINENTAL GENERAL INS .................................68124C001CONTINENTAL GENERAL INS CO ..........................67201C001CONTINENTAL LIFE INS CO ....................................37024C001COOPERATIVA DE SEGUROS DE V.......................00936C001CORNING GROUP INS DEPT ...................................14830C001CORPORATE LIFE INS CO.......................................19381C001COSMOPOLITAN LIFE INS CO ................................91365C001CROLEY LIFE INS CO...............................................75644C001CRUS AZUL DE PUERTO RICO ...............................00936C002CUNA MUTUAL INS CO ............................................35124C001CUSTOM CARE .........................................................28235C001DALLAS GENERAL LIFE ...........................................75221D001DEANCARE ................................................................53705D001DIRECT OLIN .............................................................06497D001DURHAM LIFE INS CO ..............................................27611D001EARLY AMER LIFE INS CO ...................................... 55121E001EASY CHOICE USA ................................................... 25301E001EBA ............................................................................. 64193E001EDS FEDERAL CORP ............................................... 66604E001EDS MEDICAL ........................................................... 95852E001EDUCATORS MUTUAL ............................................. 84107E001EGIP ........................................................................... 73124E001ELECTRIC MUTUAL BENEFIT A .............................. 84127E001ELECTRONICS DATA SYSTEM ............................... 82003E001EQUALIZER ............................................................... 48226E001EQUITABLE LIFE ASSN SOC O............................... 18042E001 300 MORRISON AVENUE EASTON, PA 18042EQUITABLE LIFE ASSN SOC O............................... 84110E001 ATTN: GENEVIEVE GALLOWAY PO BOX 2460 SALT LAKE CITY, UT 84110-246060EQUITABLE LIFE ASSURANCE CO ......................... 66205E001 FAIR OFF CTR SHAWNEE MISSION, KS 66205EQUITABLE LIFE ASSURANCE CO ......................... 87190E001 PO BOX 3310 ALBUQUERQUE, NM 87190-331010EXECUTIVE FUND INS CO....................................... 90403E001FARM FAMILY LIFE INS CO ..................................... 12201F001FARMERS STOCKMAN INS ...................................... 99210F001FEDERAL HOME COMPANIES ................................. 49017F001FEDERAL HOME LIFE............................................... 53214F001FEDERAL HOME LIFE INSURANCE ........................ 32887F001FEDERAL KEMPER INS CO ..................................... 62526F001FELRA ........................................................................ 21212F001FHP LIFE INS CO ...................................................... 92708F001FIC INS GROUP......................................................... 78714F001FIREMAN’S FUND EMPLOYERS IN ......................... 55440F001FIRST CENTENNIAL LIFE INS .................................. 80522F001FIRST CONTINENTAL LIFE ...................................... 15230F001FIRST HEALTH OF AZ INC ....................................... 85351F001FIRST NATL LIFE ...................................................... 36104F001FLEET RESERVE ASSOC ......................................... 20037F001FOREMOST LIFE INS CO ......................................... 49501F001FOUNDATION HEALTH PLAN .................................. 95670F001FOUNDATION HLTH PLAN....................................... 93712F001 PO BOX 792 FRESNO, CA 93712-079292FOUNDATION HLTH PLAN....................................... 95608F001 5030 EL CAMINO AVE CARMICHAEL, CA 95608-465030FOUNDATION HLTH PLAN....................................... 95865F001 PO BOX 255700 SACRAMENTO, CA 95865-570000FUTURE FINANCIAL ................................................. 53223F001GENERAL AMER LIFE ............................................. 63178G001GEORGIA LIFE & HLTH INS C................................. 30301G001GERBER LIFE INS CO ............................................. 10601G001


Company Name OCNA #

GH BENEFIT PLAN................................................... 50306G001GLOBE LIFE & ACCIDENT INS C.............................75221U001GOLDEN CARE ......................................................... 38119G001GOLDEN INS CO ...................................................... 29202G001GOLDEN RULE INS CO............................................ 46278G001 ATTN: TARA FLATT 7440 WOODLAND DR INDIANAPOLIS, IN 46278-172040GOLDEN RULE INS CO............................................ 62439G001 712 11TH ST. LAWRENCEVILLE, IL 62439-231612GOLDSTAR HEALTH CARE ..................................... 43015G001GOOD SAM INS CO.................................................. 93121G001GOVERNMENT WIDE INDEM.................................. 83707G001GRAYS HARBOR MED BUREAU............................. 98520G001GREAT AMER ........................................................... 32803G001GREAT AMER RESERVE INS CO ........................... 46032G001GREAT FIDELITY LIFE INS ...................................... 46801G001GREAT MIDWEST LIFE INS CO .............................. 75218G001GREAT REPUBLIC INS CO...................................... 98119G001GREAT WESTERN LIFE........................................... 43215G001 1377 DUBLIN RD. COLUMBUS, OH 43215-108777GREAT WESTERN LIFE........................................... 63105G001 7700 DOMMOMPE CLAYTON, MO 63105GREAT WESTERN LIFE........................................... 80201G001 PO BOX 950 DENVER, CO 80201-095050GREATER LACROSSE HLTH .................................. 54402G001GROUP HEALTH COOP/S CTRL ............................. 53715G001GROUP HEALTH OF SPOKANE.............................. 99204G001GROUP HLTH INC .................................................... 10036G001GROUP MGMT SERVICES INC ............................... 53151G001GUARANTEE RESERVE LIFE ................................. 60409G001GUARANTEE TRUST LIFE INS................................ 60025G001GUARDIAN LIFE ....................................................... 54913G001GULF SOUTH HEALTH PLAN.................................. 70898G001HARBOR INS CO .......................................................90010H001HARTFORD ACCIDENT & INDEMNI .........................50398H001HARTFORD INS CO ..................................................22312H001 ATTN: PAM MORMINO PO BOX 11910 ALEXANDRIA, VA 22312-097010HARTFORD INS CO ..................................................66201H001 PO BOX 757 SHAWNEE MISSION, KS 66201-075757HARTFORD LIFE & ACC CO.....................................06104H001HARVEST LIFE INS CO.............................................32887H001HAWKEYE NATL LIFE INS CO .................................50266H001HEALTH ADVANTAGE ..............................................29501H001HEALTH BENEFIT PLAN...........................................08854H001HEALTH CARE ...........................................................99016H001HEALTH CARE BENEFIT ..........................................60685H001 CNA PLAZA CHICAGO, IL 60685HEALTH CARE BENEFIT ..........................................29260H001 PO BOX 6927 COLUMBIA, SC 29260HEALTH FIRST PPO..................................................29605H001HEALTH PARTNERS OF ALABAMA .........................35209H001HEALTH SERVICES ASSOC .....................................98227H001HEALTHGUARD SERVICES INC ..............................97440H001HEALTHGUARD SERVICES OF W...........................98227H001HEALTH & LIFE INS ..................................................61105H001HEALTHLINK ..............................................................63132H001HILL COUNTRY LIFE INS CO ...................................78720H001HILL COUNTRY OF MONTANA ................................59771H001HLTH CARE SERVICE...............................................60601H001HOLY FAMILY SOCIETY OF US ...............................60434H001HOME BENEFICIAL LIFE INS ...................................23261H001HUMANA CARE PLUS ...............................................40201H002HUMANA GOLD CLAIMS ...........................................80210H001HUMANA HLTH CARE PLANS ..................................32245H001HUMANA REGIONAL SVCE CTR .............................78229H001ICI HLTH CLAIMS SERVICES .................................... 33427I001

IGG ASSOCIATION .................................................... 68175I001IHC SENIOR CARE..................................................... 84111I001ILLINOIS CENTRAL GULF ......................................... 48909I001INDUSTRIAL CASUALTY INS C................................ 60301I001INTEGRITY NATL LIFE INS ....................................... 40232I001INTER COUNTY HOSP PLAN INC............................. 19044I001INTERCONTINENTAL LIFE INS ................................. 78714I001INTERGROUP PREPAID SVCS O............................. 85710I001INTL BENEFITS SERVICES CO ................................ 76109I001INVESTORS CONSOLIDATED IN .............................. 27702I001INVESTORS DIVERSIFIED INS ................................. 70816I001INVESTORS HERITAGE LIFE I.................................. 40602I001ITT LIFE INS CORP .................................................... 55441I001J C STEELE & SONS INC ......................................... 27702J001JC PENNY LIFE INS CO............................................ 75221J001JEFFERSON LIFE INS CO ........................................ 75243J001JOINT BENEFIT TRUST ............................................ 94551J001KAISER GROWN HLTH PLAN ..................................20016K001KAISER PERMANENTE ............................................90041K001KANAWHA INS CO ....................................................29721K001KEYSTONE INS CO...................................................19103K001KING COUNTY BLUE SHIELD ..................................50398K001KING COUNTY MEDICAL..........................................98101K001KITSAP PHYSICIANS SRVC.....................................98310K001KLAMATH MEDICAL..................................................97601K001LEGAL SECURITY LIFE INS C................................. 75185L001LIBERTY LIFE INS CO .............................................. 29602L001LIBERTY MUTUAL INS CO ....................................... 90804L001LIBERTY NATL LIFE INS CO .................................... 35207L001LIFE INS CO OF CONNECTICUT ............................. 57193L001LIFE INS CO OF GEORGIA ....................................... 35289L001LIFE INS CO OF VIRGINIA ........................................ 19053L001LIFE INSURANCE OF VA .......................................... 24540L001LIFE INVESTORS CO................................................ 52402L001LIFE OF AMERICA ..................................................... 77019L001LIFE OF GEORGIA ASSOC DR ................................ 35209L001LIFE OF GEORGIA INS ............................................. 31999L001LIFE & HLTH INS CO OF AME.................................. 19103L001LINCOLN LIFE & CAS CO ......................................... 68501L001LINCOLN MUT LIFE & CAS IN .................................. 58107L001LINCOLN NATIONAL INS .......................................... 21701L001LUTHERAN BROTHERHOOD INS ............................ 55415L001MARICOPA MANAGED CARE SYS......................... 85034M001MARITIME ASSOC ................................................... 77034M001MARKET EMPLOYEES ASSOCIATIO ..................... 28222M001MARSH & MCCLELLAN GRP................................... 60606M002MASSACHUSETTS MUTUAL ................................... 20063M002MAXICARE ................................................................ 28217M001MEDCENTERS SENIOR LINK .................................. 55435M001MEDI PAK.................................................................. 77203M001MEDICAL SERV ADMIN OF MI ................................ 50309M001MEDICAL SERVICE CORP ...................................... 99220M001MEDICAL SERVICE OF D C.................................... 20065M001MEDICARE-AID......................................................... 27622M001MEDICO LIFE INS CO .............................................. 68103M001MEDICOMP ............................................................... 04104M001 PO BOX 9790 PORTLAND, ME 04104-509090MEDICOMP ............................................................... 29609M001 1300 RUTHERFORD RD GREENVILLE, SC 29609-310000MEDIPLUS ................................................................ 50398M001MEMORIAL LIFE INS CO ......................................... 54402M001MENNONITE MUTUAL AID ...................................... 46526M001METROPOLITAN LIFE INS ...................................... 08807M001MID AMER MUT LIFE INS CO.................................. 55113M001MID SOUTH INS CO ................................................. 28302M001MIDAMERICA MUTUAL LIFE INS ............................ 60606M001MII LIFE INCORPORATED ....................................... 55164M001MILICARE - FLEET RESERVE AS ........................... 20063M001MINNESOTA COMP HLTH ASSOC ......................... 55164M002MINNESOTA PROTECTIVE LIFE I.......................... 68114M001MONTGOMERY WARD LIFE INS CO ...................... 60197M001MONUMENTAL GENERAL INS CO ......................... 18504M001MONY ........................................................................ 77006M001MOUNTAIN STATE BCBS ........................................ 26003M001

Company Name OCNA #


Company Name OCNA # Company Name OCNA #

MPS OF MICHIGAN.................................................. 48266M001MUTUAL BENEFIT CO ............................................. 29260M001MUTUAL LIFE INS CO.............................................. 20037M001 1255 23RD ST NW WASHINGTON, DC 20037-112555MUTUAL LIFE INS CO.............................................. 35064M001 701 LLOYD NOLAN PKY FAIRFIELD, AL 35064-266001MUTUAL LIFE INS CO OF NY .................................. 10577M001MUTUAL OF NEW YORK ......................................... 10019M001MUTUAL OF OMAHA ................................................ 68131M001MUTUAL PROT MEDICO LIFE................................. 68172M001MUTUAL SERVICE LIFE INS C................................ 55164M003N CENTRAL 65 PLUS ................................................54402N001NATIONAL LIBERTY GROUP ...................................19493N002NATIONWIDE LIFE INS CO ......................................43216N001NATL BENEFIT CORP ...............................................64111N001NATL BENEFIT LIFE INS CO ....................................10016N001NATL CASUALTY INS ...............................................63101N001NATL COUNCIL SR CITIZEN ....................................10533N001NATL FARMERS UNION LIFE...................................64199N001NATL FARMERS UNION LIFE INS ...........................80231N001NATL FINANCIAL INS CO .........................................75266N001NATL FOUNDATION LIFE .........................................76102N001NATL HEALTH INS CO ..............................................75261N001NATL HERITAGE INS ................................................78720N001NATL HOME LIFE ASSUR.........................................13901N001 ATTN: ART KLOSE 1 MARINE MIDLAND PLZ BINGHAMTON, TX 13901-321601NATL HOME LIFE ASSUR.........................................19493N001 ATTN: MEDIGAP UNIT 20 MOORES RD VALLEY FORGE, PA 19493NATL LIFE ..................................................................92049N001NATL LIFE INS CO OF TEXAS .................................76015N001NATL SECURITY INS CO..........................................17901N001NATL STATES INS ....................................................50306N001NATL STATES INS CO ..............................................63141N001NATL TRAVELERS LIFE ...........................................50309N001NATL VISION .............................................................85060N001NAUS - UNISERVICE ................................................20852N001NEW YORK LIFE........................................................30348N001NEW YORK LIFE INS ............................................... 68131M001NORTH AMER INS CO ..............................................53744N001 ATTN: KAREN TRAINER PO BOX 44160 MADISON, WI 53744-416060NORTH AMER INS CO ..............................................55440N001 4000 OLSON MEMORIAL HW PO BOX 503 MINNEAPOLIS, MN 55440-9863NORTH AMER INS CO ..............................................64111N002 ATTN: MEDIGAP UNIT BROADWAY AT 34TH ST KANSAS CITY, MO 64111NORTH ATLANTIC CAS & SURE ..............................46206N001NORTH CAROLINA MUTUAL....................................37202N001NORTHWESTERN NATL LIFE ..................................56143N001NORTHWESTERN PUBLIC SERVICE ......................57350N001NWNL HEALTH MANAGEMENT CO.........................55440N001OKLAHOMA STATE INS ........................................... 73124O001OLD AMER INS CO .................................................. 64141O001OLD SOUTHERN LIFE INS CO ................................ 36101O001OLD SURETY LIFE INS CO ..................................... 73154O001OREGON PACIFIC STATES .................................... 97207O001PACIFIC HOSPITAL ASSOCIAT ...............................97401P001PACIFIC MUTUAL LIFE .............................................91203P001 620 N BRAND BLVD GLENDALE, CA 91203-123920PACIFIC MUTUAL LIFE .............................................98003P001 33400 8TH AVE S FEDERAL WAY, WA 98003-638200PACIFIC NORTHWEST LIFE IN ................................97207P001PANHANDLE EASTERN CORP ................................77251P001PARK & SHOP INS ....................................................53801P001

PAUL REVERE LIFE INS CO ....................................01608P001PEARCE IND..............................................................77235P001PEHP..........................................................................84102P001PEIA HEALTH ECON CORP .....................................25362P001PEKIN LIFE INS CO...................................................61558P001PENINSULAR LIFE INS CO ......................................27605P001PENN GENERAL SVCS OF GA ................................30358P001PENN TREATY LIFE INS CO ....................................18105P001PENNSYLVANIA LIFE INS ........................................90406P001PEOPLES LIFE INS CO.............................................60008P001 PO BOX 5090 ROLLING MEADOWS, IL 60008PEOPLES LIFE INS CO.............................................29609P001 1300 RUTHERFORD ROAD GREENVILLE, SC 29609PEOPLES SECURITY INS ........................................24540P001PEOPLES SECURITY LIFE INS ................................27702P001PFWB BENEVOLENT ASSO .....................................28335P001PHILADELPHIA AMER ..............................................19034P001PHYSICIANS HLTH PLAN.........................................55440P001PHYSICIANS MUTUAL INS CO ............................... 68131M001PIERCE COUNTY MED BUREAU.............................98401P001PILGRIM LIFE INS CO...............................................19032P001PILOT LIFE INS CO ...................................................37220P001PIONEER LIFE INS CO .............................................61105P001PLAN 65 OF KANSAS................................................66629P001PREFERRED ADMINISTRATIVE SE........................53715P001PREFERRED BANKERS LIFE IN ..............................75205P001PREFERRED CHOICE...............................................92196P001PREFERRED HLTH CARE ........................................67214P001PREFERRED LIFE INS CO OF NY ...........................10019P001PREFERRED RISK LIFE ...........................................50265P001PRESIDENTIAL LIFE.................................................75228P001PRIME CARE PLUS ...................................................43235P001PRIME HLTH ..............................................................64134P001PRINCIPAL HLTH CARE ...........................................64141P001PRINCIPAL MUTUAL INS ..........................................55430P001PRINCIPAL MUTUAL LIFE ........................................68154P001PROTECTED HOME MUT LIFE I..............................16146P001PROTECTIVE LIFE INS CO ......................................35202P001PROVIDENCE LIFE ...................................................38187P001PROVIDENT CLAIM OFFICE ....................................37422S001PROVIDENTIAL LIFE INS CO ...................................72203P001PROVIDERS FIDELITY LIFE I...................................19422P001PYRAMID LIFE INS CO .............................................66202P001QUAL-MED INC ......................................................... 87110Q001R E HARRINGTON INC .............................................28226R001RAND MCNALLY ........................................................29609R001RELIABLE LIFE INS CO ............................................63119R001RESERVE NATL LIFE IN ...........................................73118R001RHONE POULENE OF WY ........................................82935R001RHULEN INS CO........................................................12701R001RISK MANAGEMENT INC .........................................93794R001RURAL SECURITY LIFE INS C.................................53705R001SAN ANTONIO REG CLAIM CTR .............................78216S001SAVERS LIFE INS CO ...............................................27103S001SDC - SYSTEM DEVELOPMENT..............................73154S002SECURE CARE ..........................................................19493S001SECURE HORIZONS HLTH PL .................................90630S001SECURITY GENERAL INS ........................................37422S001SECURITY GENERAL LIFE INS ...............................73154S001SECURITY HLTH PLAN OF WI .................................54449S001SECURITY LIFE INS CO ...........................................77019S001SECURITY NATL LIFE INS CO .................................84157S001SECURITY TRUST LIFE INS C.................................27702S001SEGUROS DE SERVICIO DE SAL ...........................00936S001SELECTCARE ............................................................08221S001SENIOR CARE ...........................................................91351S001SENIOR SECURITY LIFE INS ...................................73154S003SENTRY LIFE INS .....................................................54481S001SHELTER LIFE INS CO .............................................65218S001SIERRA HEALTH & LIFE INS ....................................89114S001SKAGIT CTY MED BUREAU INC..............................98273S001SOUTH ATLANTIC LIFE ............................................60076S001 8255 CENTRAL PARK AVE SKOKIE, IL 60076-290855


SOUTH ATLANTIC LIFE ............................................33101S001 ONE INDEPENDENT DRIVE JACKSONVILLE, FL 33001SOUTHERN FARM BUREAU LIFE............................39205S001SOUTHERN HEALTH PLAN......................................38101S001SOUTHLAND LIFE INS CO .......................................35289S001SOUTHWEST ADMINISTRATOR ..............................90057S001SOUTHWEST SERVICES LIFE.................................76118S001SOUTHWESTERN GENERAL LIFE I........................75266S001ST MICHAELS/PA ......................................................53209S001STANDARD GUARANTY INS ....................................30327S001STANDARD LIFE INS CO......................................... 68131M001STANDARD LIFE & ACC INS C................................73125S001STATE FARM INS CO ...............................................07477S001 1750 STATE RT 23 WAYNE, NJ 07477-000150STATE FARM INS CO ...............................................22909S001 1500 STATE FARM BLVD CHARLOTTESVILLE, VA 22909-000100STATE FARM INS CO ...............................................24319S001 PO BOX 1330 CHILHOWIE, VA 24319-133030STATE FARM INS CO ...............................................24605S001 PO BOX 368 BLUEFIELD, VA 24605-036868STATE FARM INS CO ...............................................28337S001 304 W BROAD ST ELIZABETHTOWN, NC 28337-939604STATE FARM INS CO ...............................................28472S001 303 JEFFERSON ST WHITEVILLE, NC 28472-360103STATE FARM INS CO ...............................................28645S001 226 THRIFT ST LENOIR, NC 28645STATE FARM INS CO ...............................................30136S001 HEALTH CLAIM DEPT 11350 JOHNS CREEK PKY DULUTH, GA 30136-154150STATE FARM INS CO ...............................................32232S001 8001 BAYMEADOWS DR JACKSONVILLE, FL 32232-5061STATE FARM INS CO ...............................................37131S001 ATTN: MEDIGAP UNIT 2500 MEMORIAL BLVD MURFREESBORO, TN 37131-000100STATE FARM INS CO ...............................................55161S001 1500 HIGHWAY 36 W ST. PAUL, MN 55161-000100STATE FARM INS CO ...............................................61709S001 ATTN: LISA APPLE 2702 IRELAND GROVE RD BLOOMINGTON, IL 61709STATE FARM INS CO ...............................................71208S001 22 STATE FARM DR MONROE, LA 71208-000222STATE FARM INS CO ...............................................83330S001 1241 MAIN ST GOODING, ID 83330-183441STATE FARM INS CO ...............................................97303S001 4600 25TH AVE NE SALEM, OR 97303-237100STATE GROUP BENEFITS .......................................70804S001STATE MUTUAL CO ..................................................01653S001STATES GENERAL LIFE INS ....................................75214S001STATESMAN NATL LIFE...........................................77006S001STATEWIDE INS CO .................................................28110S001SUMMIT NATL LIFE INS CO .....................................17601S001SURGICAL CARE ......................................................53201S001TAKE CARE HLTH PLAN .......................................... 94524T001TEAM-CARE HEALTH CHOICE ................................ 38174T001TENNECO .................................................................. 32276T001TIME ........................................................................... 53201T001TRANSAMERICA ACCIDENTAL LIF ......................... 91785T001TRANSAMERICA INS ................................................ 91367T001TRANSPORT LIFE ..................................................... 76102T001TRAVELERS INS CO ................................................. 06517T001

Company Name OCNA #

TRAVELERS OMAHA ................................................ 68175T001TRIGON MUTUAL INS CO/ BCBS ............................ 24031B001TROA INS PLANS ...................................................... 50306T001UNDERWRITERS LIFE INS CO ................................75238U001UNION BANKERS INS CO ........................................75265U001UNION CARE LIFE INS CO .......................................20001U001UNION FIDELITY LIFE INS .......................................19047U001UNION LABOR LIFE ..................................................20006U001UNION LABOR LIFE INS CO.....................................10010U001UNION MUTUAL LIFE INS .........................................19049U001UNITED AMER INS CO .............................................75221U001UNITED ASSURANCE CO OF PA ............................19047U002UNITED COMMERCIAL TRAVLRS ...........................43215U001UNITED FAMILY LIFE INS ........................................30301U001UNITED FARM BUREAU FAMILY .............................46206U001UNITED FOUNDERS LIFE ........................................35202U001UNITED FOUNDERS LIFE INS .................................73112U001UNITED GENERAL LIFE INS C.................................33743U001UNITED GENERAL LIFE INS CO..............................34616U001UNITED HERITAGE MUTUAL ...................................83653U001UNITED INVESTORS LIFE INS .................................75221U001UNITED LIFE OF NORTH AMER ..............................22182U001UNITED METHODIST GROUP..................................68175U001UNITED OF OMAHA ..................................................19047U001UNITED SEC ASSURANCE CO O............................18964U001UNITED TECHNOLOGIES .........................................06146U001UNIVERSAL FIDELITY LIFE I...................................73533U001UNIVERSAL LIFE INS CO .........................................23222U001US GUARDIAN HEALTH INS CO ..............................75244U001USAA LIFE INS CO ....................................................78288U001 (UNITED STATES AUTOMOBILE ASSN)USABLE LIFE .............................................................72203U001VALLEY HEALTH PLAN ............................................ 54702V001VETERANS ADMINISTRATION ................................ 85012V001VETERANS LIFE INS CO .......................................... 19493V001VFW MEDICARE SUPPLEMENT .............................. 64111V001VICTORY LIFE INS CO ............................................. 37133V001VIRGINIA HLTH & ACC ASSOC ................................ 23847V001VIRGINIA MUTUAL INS CO ...................................... 23225V001VULCAN LIFE INS CO ............................................... 35201V001WALLA WALLA VALLEY MED CO ........................... 99362W001WASHINGTON NATL INS ......................................... 60201W001WC KUMMEROW & CO............................................ 60014W001WEA INSURANCE GROUP ...................................... 53708W001WESTERN FARM BUREAU INS .............................. 80217W001WESTERN FIDELITY INS ......................................... 76101W001WHATCOM MEDICAL BUREAU............................... 98227W001WISCONSIN HLTH ORGANIZ .................................. 53212W001WISCONSIN PHYSICIANS SERVIC ........................ 53701W001WORLD INS CO ........................................................ 68130W001WORLD LIFE & HLTH INS CO ................................. 17105W001

Company Name OCNA #


Suppliers are not permitted to qualify patients for oxygen services under the Medicareprogram by performing the Arterial Blood Gas (ABG) or oximetry tests. A physicianor certified provider, (i.e., qualified provider of laboratory services) is to order andevaluate these tests results. This information is then submitted to Palmetto GBAthrough a completed HCFA-484 form. When the patient’s PO2 level exceeds 59mmHg or the arterial blood saturation exceeds 89 percent at rest at room air, the physicianmust supplement the completed HCFA-484 form by submitting evidence justifying hisor her oxygen prescription, including a statement of having tried and failed with the useof more conservative types of therapy in treating the patient’s hypoxemia.

As documented in the DMEPOS Supplier Manual page 14.8 ... “Qualifying tests mustbe conducted by a physician or a provider certified to conduct such a tests. Becauseof the potential conflict of interest, the results of the oximetry tests conducted by aDurable Medical Equipment (DME) supplier cannot be accepted to establish the needfor home oxygen therapy on initial claims or when accompanying recertification. Theprohibition does not extend to the results of tests conducted by a hospital that is acertified provider of such services which may also furnish home oxygen therapy to thepatient directly or through an associated organization.”

Under the False Claims Act, the United States Attorney from the Eastern District ofPennsylvania charged National Royal Corporation and Home Health Care Products,Inc. with delivering medical equipment which was never ordered by the patient, billingMedicare for goods that did not comply with program requirements, and obtainingsignatures on false Certificates of Medical Necessity (CMNs). In May of 1994, a pressrelease issued by United States Attorney, Michael Stiles, Regional Inspector General,Jack Hartwig, and Federal Bureau of Investigation Special Agent in Charge, DodgeFredrick, announced the successful conclusion of this case with a $21 millionsettlement and a lifetime exclusion from participation in the Medicare program.

The following suppliers are being excluded from participation in the Title XVIII(Medicare) program, per Office of Inspector General, Office of Investigations, P.O.Box 2288, Atlanta, GA 30301.

Florida

Frank J. Ballesteros Specialty: Family Physician/GP11709 SW 114th Avenue DOB: 09/13/54Miami, FL 33139 Period of Exclusion: 10 YearsAuthority: 1128 (a) (1)

Phoenix Medical Corp. Specialty: Home Health Agency(Juliet Miller) DOB: N/A1140 NE 163rd St. Suite 7 Period of Exclusion: 10 yrs.Miami, FL 33162Authority: 1128 (a) (1)

Ramon Thomas Quirantes Specialty: DME/General671 Nightingale Avenue DOB: 12/21/26Miami Springs, FL 33166 Period of Exclusion: 5 yrs.Authority: 1128 (a) (1)

Ramon Quirantes Specialty: Orthopedics4180 W. 12th Avenue DOB: N/AHialeah, FL 33012 Period of Exclusion: 5 yrs.Authority: 1128 (a) (1)

Facts: Convicted of a crime related to the Medicaid Program.

ANTI-FRAUD UNIT

Supplier Sanctions

Anti-Fraud Reminder


Respiratory Health Care Specialty: DME/General(Stephen H. Wilkinson) Period of Exclusion: 10 Years2441 NW 93rd Ave. #103Miami, FL 33172Authority: 1128 (b) (8)

Facts: Excluded based on owner's conviction.

Stephen Harold Wilkinson Specialty: DME/General(Respiratory Health Care) DOB: 06/25/4131 Lakeside Circle Period of Exclusion: 10 YearsPahokee, FL 33476Authority: 1128 (a) (1)

Facts: Convicted of a crime related to the Medicare Program.

Georgia

Coleman Pharmacy Period of Exclusion: 10 Years(Thomas C. Coleman, Jr.)616 Central Dr.East Dublin, GA 31021Authority: 1128 (b) (1)


Thomas Clinton Coleman, Jr. Specialty: Owner/Operator(Coleman Pharmacy) DOB: 05/18/47335 Trinity Rd. (Rte. 10) Period of Exclusion: IndefiniteDublin, GA 31020Authority: 1128 (b) (1)


Peter G. Cutler Specialty: Owner/Operator616 Central Drive DOB: 09/02/60Lilburn, GA 30247 Period of Exclusion: IndefiniteAuthority: 1128 (b) (14)


Donald Ricci Specialty: Owner/Operator(Liberty Convalescent) DOB: 07/12/52614 Sandy Run Drive Period of Exclusion: 10 YearsHinesville, GA 31021Authority: 1128 (b) (1)

North Carolina

Royal Crest Health Specialty: Care FacilityBarbara Whittle DOB: N/A398 Wilkinson Road Period of Exclusion: 5 yrs.Gastonia, NC 28052Authority: 1128 (a) (1)


ANTI-FRAUD UNIT(Cont'd)


South Carolina

Arquita Lynette Hogue Specialty: Occupational Therapistaka Arquita Brooks DOB: 06/02/60700 Bluebell Lane Period of Exclusion: 5 YearsLaurel Bay, SC 29902Authority: 1128 (A) (1)

Tennessee

Otis Campbell, Jr. Specialty: Family Physician/G.P.Warren Reg. Prof. Bldg. DOB: 09/09/51McMinnville, TN 37110 Period of Exclusion: IndefiniteAuthority: 1128 (b) (14)

Facts: Defaulted on Public Health Service Education loan.

Texas

James A. Welch Specialty: Owner/Operator(Judy K. Yelderman-Welch) DOB: 10/05/37Route 11, Box 842 Period of Exclusion: 5 YearsOrange, TX 77632Authority: 1128 (b) (1)

Judy K. Yelderman-Welch Specialty: Owner/Operator(James A. Welch) DOB: 11/09/51P.O. Box 216 Period of Exclusion: 5 YearsOrangefield, TX 77639Authority: 1128 (b) (1)

Facts: Convicted of submitting false claims to Medicare for Home Health Agencyservices.

ANTI-FRAUD UNIT(Cont'd)

The following K codes have been recategorized from Prosthetics and Orthotics toInexpensive and Routinely Purchased. This change means that Medicare will nolonger cover these items for patients in skilled nursing facilities or nursing facilities.Items classified as Durable Medical Equipment (DME) are only covered in thepatient's home [Place of Service (POS) 12] or a custodial care facility (POS 33).

K0115 Orthotic seating system, back module, posterior-lateral control, with orwithout lateral supports, custom fabricated for attachment to wheelchairbase.

K0116 Orthotic seating system, combined back and seat module, custom fabricatedfor attachment to wheelchair base.

Pricing for these codes follows.

RECATEGORIZATIONOF ORTHOTICSEATING SYSTEMS


The following fee schedule matrix is an update to the schedule previously publishedin the January 1994 DMERC Medicare Advisory.

1994 DME FEESCHEDULE UPDATE

UPDATED 1994 DME FEE SCHEDULES FOR PUERTO RICO ONLY

A4613NU - 92.75 A4618NU - 8.50 E0193RR - 1424.04 E0225NU - 421.13 E0225UE- 315.85 E0225RR - 52.64

E0239NU - 346.50 E0239UE - 259.88 E0239RR - 43.31 E0460RR - 708.41 E0575RR - 90.60 E0998NU - 43.57 E0998UE - 32.68 E0998RR - 5.45

UPDATED 1994 DME FEE SCHEDULES FOR TENNESSEE FOR DYNASPLINT HCPCS CODES

YY001RR - 92.01 YY003RR - 90.08

UPDATED 1994 DME FEE SCHEDULES

HCPCS AL AR CO FL G A KY LA MS NC NM O K PR SC TN TX VI

E0935 16.98 18.74 19.98 19.98 16.98 19.98 19.26 16.98 18.45 16.98 16.98 14.89 16.98 16.98 19.98 16.98

K0110 19.89 19.89 19.89 19.89 19.89 19.89 19.89 19.89 19.89 19.89 19.89 23.88 19.89 19.89 19.89 19.89

K0111 41.07 41.07 41.07 39.49 41.07 41.07 41.07 41.07 40.69 41.07 41.07 47.38 41.07 41.07 39.49 41.07

K0131 15.85 15.85 15.85 15.85 15.85 15.85 15.85 15.85 15.85 15.85 15.85 19.04 15.85 15.85 15.85 15.85

K0164 3.29 3.29 3.29 3.22 3.29 3.29 3.29 3.29 3.29 3.29 3.29 3.87 3.29 3.29 3.29 3.22

REVISED 1994 DME FEE SCHEDULES - CAPPED RENTAL ITEMS

RENTAL AL AR CO FL G A KY LA MS NC NM O K PR SC TN TX VI

K0001 40.80 48.00 48.00 40.80 41.34 43.80 47.16 40.80 40.80 42.21 48.00 * 45.06 40.80 48.00 45.32

K0002 71.91 71.91 71.91 61.12 61.12 71.91 71.91 61.12 64.13 71.91 68.19 * 71.91 61.12 71.91 71.54

K0003 78.74 78.74 78.74 66.93 77.75 66.93 78.74 66.93 66.93 78.74 76.52 * 78.74 78.74 78.74 70.51

K0004 99.83 99.83 99.83 99.83 99.83 114.65 99.83 99.83 109.39 117.45 117.45 * 117.45 117.45 117.45 117.45

K0006 95.90 93.68 110.21 93.68 110.21 98.50 93.68 93.68 103.09 110.21 110.21 * 93.68 110.21 110.21 110.21

K0010 318.23 318.23 374.39 318.23 318.23 318.23 318.23 318.23 318.23 374.39 374.39 * 318.23 318.23 318.23 318.23

K0101 33.70 38.35 38.35 34.02 37.70 38.35 38.35 34.64 38.35 34.74 38.35 * 38.35 34.38 35.06 38.10

K0195 10.43 10.43 9.34 9.35 10.43 8.87 8.87 8.87 9.18 10.43 8.87 * 8.87 8.87 10.43 10.43

1994 DME FEE SCHEDULES - INEXPENSIVE OR ROUTINELY PURCHASED ITEMS

NEW AL AR CO FL G A KY LA MS NC NM O K PR SC TN TX VI

E0669 159.08 159.08 159.08 152.99 159.08 159.08 159.08 159.08 157.57 159.08 159.08 * 159.08 159.08 152.99 159.08

K0115 764.06 764.06 764.06 764.06 764.06 764.06 764.06 764.06 764.06 764.06 764.06 * 764.06 764.06 764.06 764.06

K0116 1,594.77 1,594.77 1,594.77 1,594.77 1,594.77 1,594.77 1,594.77 1,594.77 1,594.77 1,594.77 1,594.77 * 1,594.77 1,594.77 1,594.77 1,594.77

USED AL AR CO FL G A KY LA MS NC NM O K PR SC TN TX VI

E0669 120.85 120.85 120.85 114.74 119.33 120.48 120.85 120.85 118.18 120.85 120.76 * 120.48 120.85 114.74 120.48

K0115 573.05 573.05 573.05 573.05 573.05 573.05 573.05 573.05 573.05 573.05 573.05 * 573.05 573.05 573.05 573.05

K0116 1,196.09 1,196.09 1,196.09 1,196.09 1,196.09 1,196.09 1,196.09 1,196.09 1,196.09 1,196.09 1,196.09 * 1,196.09 1,196.09 1,196.09 1,196.09

RENTAL AL AR CO FL G A KY LA MS NC NM O K PR SC TN TX VI

E0669 16.11 16.11 16.11 15.31 15.90 16.07 16.11 16.11 15.76 16.11 16.10 * 16.07 16.11 15.31 16.07

K0115 76.42 76.42 76.42 76.42 76.42 76.42 76.42 76.42 76.42 76.42 76.42 * 76.42 76.42 76.42 76.42

K0116 159.49 159.49 159.49 159.49 159.49 159.49 159.49 159.49 159.49 159.49 159.49 * 159.49 159.49 159.49 159.49

REVISED 1994 DME FEE SCHEDULES - SUPPLIES/ACCESSORIES

AL AR CO FL G A KY LA MS NC NM O K PR SC TN TX VI

A4253 37.41 37.41 31.85 37.41 34.67 36.50 37.41 37.41 32.45 32.35 31.80 * 34.32 37.41 33.72 37.41

A4557 * * * * * * * * * 18.44 * * * * * *

A4558 4.79 4.79 4.79 4.55 4.79 4.79 4.07 4.34 4.79 4.07 4.79 * 4.07 4.07 4.07 4.07

REVISED 1994 P&O FEE SCHEDULES

AL AR CO FL G A KY LA MS NC NM O K PR SC TN TX VI

L1844 1,089.40 1,087.49 1,169.69 1,089.40 1,089.40 1,089.40 1,087.49 1,089.40 1,089.40 1,087.49 1,087.49 1,269.07 1,089.40 1,089.40 1,087.49 1,065.46

* No change


1994 DME FEESCHEDULE REVISION(Cont'd)

1994 SURGICAL DRESSINGS FEE SCHEDULE

HCPCS FL G A NC SC AL KY MS TN AR LA O K TX NM CO PR VI

A4460 0.89 0.89 0.89 0.89 0.89 0.89 0.89 0.89 0.89 0.89 0.89 0.89 0.89 0.89 0.80 0.89K0154 12.24 12.63 12.61 12.63 12.63 12.63 12.63 12.63 12.63 12.63 12.63 12.24 12.63 12.63 13.83 12.63K0196 9.72 9.72 9.72 9.72 9.72 9.72 9.72 9.72 9.72 9.72 9.72 9.72 9.72 9.72 11.67 9.72K0197 15.44 15.44 15.44 15.44 15.44 15.44 15.44 15.44 15.44 15.44 15.44 15.44 15.44 15.44 18.53 15.44K0198 112.50 112.50 112.50 112.50 112.50 112.50 112.50 112.50 112.50 112.50 112.50 112.50 112.50 112.50 135.00 112.50K0199 4.39 4.39 4.39 4.39 4.39 4.39 4.39 4.39 4.39 4.39 4.39 4.39 4.39 4.39 5.26 4.39K0203 1.58 1.58 1.58 1.58 1.58 1.58 1.58 1.58 1.58 1.58 1.58 1.58 1.58 1.58 1.90 1.58K0204 2.77 2.77 2.77 2.77 2.77 2.77 2.77 2.77 2.77 2.77 2.77 2.77 2.77 2.77 3.33 2.77K0205 4.57 4.57 4.57 4.57 4.57 4.57 4.57 4.57 4.57 4.57 4.57 4.57 4.57 4.57 5.49 4.57K0206 0.97 0.97 0.97 0.97 0.97 0.97 0.97 0.97 0.97 0.97 0.97 0.97 0.97 0.97 1.15 0.97K0207 1.68 1.68 1.68 1.68 1.68 1.68 1.68 1.68 1.68 1.68 1.68 1.68 1.68 1.68 2.02 1.68K0208 3.42 3.42 3.42 3.42 3.42 3.42 3.42 3.42 3.42 3.42 3.42 3.42 3.42 3.42 4.08 3.42K0209 5.33 5.33 5.33 5.33 5.33 5.33 5.33 5.33 5.33 5.33 5.33 5.33 5.33 5.33 6.39 5.33K0210 10.38 10.38 10.38 10.38 10.38 10.38 10.38 10.38 10.38 10.38 10.38 10.38 10.38 10.38 12.46 10.38K0211 26.04 26.04 26.04 26.04 26.04 26.04 26.04 26.04 26.04 26.04 26.04 26.04 26.04 26.04 31.24 26.04K0212 6.62 6.62 6.62 6.62 6.62 6.62 6.62 6.62 6.62 6.62 6.62 6.62 6.62 6.62 7.95 6.62K0214 14.63 14.63 14.63 14.63 14.63 14.63 14.63 14.63 14.63 14.63 14.63 14.63 14.63 14.63 17.54 14.63K0215 2.33 2.33 2.33 2.33 2.33 2.33 2.33 2.33 2.33 2.33 2.33 2.33 2.33 2.33 2.79 2.33K0216 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.08 0.10 0.08K0217 0.35 0.35 0.35 0.35 0.35 0.35 0.35 0.35 0.35 0.35 0.35 0.35 0.35 0.35 0.42 0.35K0218 0.58 0.58 0.58 0.58 0.58 0.58 0.58 0.58 0.58 0.58 0.58 0.58 0.58 0.58 0.69 0.58K0219 0.27 0.27 0.27 0.27 0.27 0.27 0.27 0.27 0.27 0.27 0.27 0.27 0.27 0.27 0.32 0.27K0220 0.66 0.66 0.66 0.66 0.66 0.66 0.66 0.66 0.66 0.66 0.66 0.66 0.66 0.66 0.78 0.66K0222 2.28 2.28 2.28 2.28 2.28 2.28 2.28 2.28 2.28 2.28 2.28 2.28 2.28 2.28 2.73 2.28K0223 2.45 2.45 2.45 2.45 2.45 2.45 2.45 2.45 2.45 2.45 2.45 2.45 2.45 2.45 2.95 2.45K0224 2.54 2.54 2.54 2.54 2.54 2.54 2.54 2.54 2.54 2.54 2.54 2.54 2.54 2.54 3.06 2.54K0229 1.41 1.41 1.41 1.41 1.41 1.41 1.41 1.41 1.41 1.41 1.41 1.41 1.41 1.41 1.70 1.41K0234 4.55 4.55 4.55 4.55 4.55 4.55 4.55 4.55 4.55 4.55 4.55 4.55 4.55 4.55 5.47 4.55K0235 10.65 10.65 10.65 10.65 10.65 10.65 10.65 10.65 10.65 10.65 10.65 10.65 10.65 10.65 12.78 10.65K0236 19.59 19.59 19.59 19.59 19.59 19.59 19.59 19.59 19.59 19.59 19.59 19.59 19.59 19.59 23.51 19.59K0237 4.48 4.48 4.48 4.48 4.48 4.48 4.48 4.48 4.48 4.48 4.48 4.48 4.48 4.48 5.38 4.48K0238 16.97 16.97 16.97 16.97 16.97 16.97 16.97 16.97 16.97 16.97 16.97 16.97 16.97 16.97 20.36 16.97K0239 18.24 18.24 18.24 18.24 18.24 18.24 18.24 18.24 18.24 18.24 18.24 18.24 18.24 18.24 21.90 18.24K0240 7.96 7.96 7.96 7.96 7.96 7.96 7.96 7.96 7.96 7.96 7.96 7.96 7.96 7.96 9.56 7.96K0241 1.49 1.49 1.49 1.49 1.49 1.49 1.49 1.49 1.49 1.49 1.49 1.49 1.49 1.49 1.79 1.49K0242 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 4.75 5.70 4.75K0243 8.98 8.98 8.98 8.98 8.98 8.98 8.98 8.98 8.98 8.98 8.98 8.98 8.98 8.98 10.77 8.98K0244 17.71 17.71 17.71 17.71 17.71 17.71 17.71 17.71 17.71 17.71 17.71 17.71 17.71 17.71 21.24 17.71K0245 6.50 6.50 6.50 6.50 6.50 6.50 6.50 6.50 6.50 6.50 6.50 6.50 6.50 6.50 7.80 6.50K0246 11.51 11.51 11.51 11.51 11.51 11.51 11.51 11.51 11.51 11.51 11.51 11.51 11.51 11.51 13.80 11.51K0247 21.25 21.25 21.25 21.25 21.25 21.25 21.25 21.25 21.25 21.25 21.25 21.25 21.25 21.25 25.49 21.25K0248 12.74 12.74 12.74 12.74 12.74 12.74 12.74 12.74 12.74 12.74 12.74 12.74 12.74 12.74 15.30 12.74K0249 0.96 0.96 0.96 0.96 0.96 0.96 0.96 0.96 0.96 0.96 0.96 0.96 0.96 0.96 1.14 0.96K0251 1.64 1.64 1.64 1.64 1.64 1.64 1.64 1.64 1.64 1.64 1.64 1.64 1.64 1.64 1.97 1.64K0252 1.73 1.73 1.73 1.73 1.73 1.73 1.73 1.73 1.73 1.73 1.73 1.73 1.73 1.73 2.08 1.73K0253 4.23 4.23 4.23 4.23 4.23 4.23 4.23 4.23 4.23 4.23 4.23 4.23 4.23 4.23 5.09 4.23K0254 1.26 1.26 1.26 1.26 1.26 1.26 1.26 1.26 1.26 1.26 1.26 1.26 1.26 1.26 1.50 1.26K0255 1.82 1.82 1.82 1.82 1.82 1.82 1.82 1.82 1.82 1.82 1.82 1.82 1.82 1.82 2.18 1.82K0257 0.44 0.44 0.44 0.44 0.44 0.44 0.44 0.44 0.44 0.44 0.44 0.44 0.44 0.44 0.54 0.44K0258 2.79 2.79 2.79 2.79 2.79 2.79 2.79 2.79 2.79 2.79 2.79 2.79 2.79 2.79 3.36 2.79K0259 5.24 5.24 5.24 5.24 5.24 5.24 5.24 5.24 5.24 5.24 5.24 5.24 5.24 5.24 6.29 5.24K0263 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.16 0.21 0.16K0264 0.21 0.21 0.21 0.21 0.21 0.21 0.21 0.21 0.21 0.21 0.21 0.21 0.21 0.21 0.25 0.21


TELEPHONE DIRECTORY

Region C DMERC

Region C DMERC General Information (effective 10/1/94) ............................................................... (803) 691-4300Region C DMERC Professional Relations ....................................................................................... (803) 735-1034Region C DMERC Ombudsmen ... (Refer to page 94-87 of the March 1994 issue of the DMERC Medicare Advisory.)

Electronic Data Interchange ........................................................................................................... (803) 788-9751Prior Authorization ......................................................................................................................... (803) 735-9353Anti-Fraud and Abuse Unit ............................................................................................................. (803) 788-5414

National

HCPCS Help-Line ......................................................................................................................... (803) 736-6809National Supplier Clearinghouse .................................................................................................... (803) 754-9282

The Region C DMERC Medicare Advisory is published by Palmetto Government Benefits Administrator's Professional RelationsDepartment for suppliers and providers of DMEPOS. Questions regarding information in Palmetto GBA publications can be addressed to:

Palmetto Government Benefits AdministratorsProfessional Relations Department

P.O. Box 100141Columbia, SC 29202-3141

or call (803) 735-1034, Ext. 5740 or Ext. 5741


GLOSSARY

AARP American Association of Retired PersonsAKA Also Known AsALJ Administrative Law JudgeANSI American National Standards InstituteARU Audio Response UnitAWP Average Wholesale PriceCMN Certificate of Medical NecessityCPAP Continuous Positive Airway PressureCPM Continuous Passive MotionCWF Common Working FileDME Durable Medical EquipmentDMEPOS Durable Medical Equipment, Prosthetics, Orthotics, and SuppliesDMERC Durable Medical Equipment Regional CarrierDOB Date of BirthEDI Electronic Data InterchangeEFT Electronic Funds TransferEMC Electronic Media ClaimEOB Explanation of BenefitsEOMB Explanation of Medicare BenefitsEPO Epoetin AlphaERN Electronic Remittance NoticeESRD End-Stage Renal DiseaseFDA Food and Drug AdministrationGHP Group Health PlanHCFA Health Care Financing AdministrationHCPCS HCFA Common Procedure Coding SystemHCT HematocritHICN Health Insurance Claim NumberICD-9-CM International Classification of Diseases-9th Revision-Clinical ModificationIPPB Intermittent Positive Pressure BreathingMCM Medicare Carrier's ManualMSP Medicare Secondary PayerNDC National Drug CodeNSC National Supplier ClearinghouseNSF National Standard FormatNTIS National Technical Information ServiceOBRA 93 Omnibus Budget Reconciliation Act of 1993OCNA Other Carrier Name & AddressOIG Office of Inspector GeneralP & O Prosthetics & OrthoticsPalmetto GBA Palmetto Government Benefits AdministratorsPDR Physician's Desk ReferencePEN Parenteral and Enteral NutritionPOS Place of ServicePOV Power Operated VehicleRMRP Regional Medical Review PoliciesRRB Railroad Retirement BoardSAC Supplier Advisory CommitteeSADMERC Statistical Analysis Durable Medical Equipment Regional CarrierTENS Transcutaneous Electrical Nerve StimulatorUPIN Unique Physician Identification Number


- NOTES -


- NOTES -CUMULATIVE INDEX

1993 Reasonable Charge Pricing K Codes ............................................................................................94-281994 Durable Medical Equipment Fee Schedule Corrections ...............................................................94-961994 Durable Medical Equipment Fee Schedule Revisions .........................................................94-199-2001994 HCFA Common Procedure Coding System HCPCS Update ........................................................94-631994 Pricing Matrix

1994 Pricing Matrix ..................................................................................................................... 94-33-521994 Pricing Matrix for Virgin Islands and Puerto Rico .............................................................94-97-107

Advantis Network.....................................................................................................................................94-76Alternating Pressure Mattresses (E0277) Update ................................................................................94-181Anti-Fraud and Abuse Unit ................................................................................................. 94-90, 94-196-198Audio Response Unit (ARU) For Claim Status .....................................................................................94-178Certificate of Medical Necessity

Certificate of Medical Necessity: Deferred Implementation ..............................................................94-4Certificate of Medical Necessity Submission ............................................................................. 94-11-12

Certified Software Vendors, Billing Services & Clearinghouses .......................................................94-77-84Claim Payment .................................................................................................................................. 94-14-15Claims Jurisdiction ............................................................................................................................ 94-15-18Coding: How to Obtain Reference Material .............................................................................................94-6Complementary Insurers ................................................................................................94-20, 94-63, 94-192Continuous Passive Motion (CPM) Device Units Billing Instruction .....................................................94-181Crossover Problem Identified .................................................................................................................94-57Crossover Update ..........................................................................................................................94-189-190DMEPOS Supplier Specialty Workshops Notice ....................................................................................94-85DMERC Certified Software Vendors ................................................................................................ 94-22-26DMERC Medicare Advisory Update......................................................................................................94-184Electronic Data Interchange (EDI)

Added Benefit ..................................................................................................................................94-178Help-Line: Commonly Asked Questions ...........................................................................................94-75Remittance Advices Notices, Standard Reason Codes .................................................................94-181Update ...............................................................................................................................................94-76Agreements ................................................................................................................................. 94-21-22

Glossary .......................................................................................................................94-54, 94-109, 94-202Grandfathering Policy...........................................................................................................................94-7-10HCFA Common Procedure Coding System (HCPCS)

Coding Help-Line: Commonly Asked Questions ....................................................94-64-65, 94-185-186Additions/Changes .......................................................................................................................94-65-66Codes Requiring A CMN ..............................................................................................................94-67-71

Helpful Hints .................................................................................................................................. 94-179-180ICD-9-CM Information .............................................................................................................................94-26Level II HCPCS Codes for Elevating Leg Rests ......................................................................................94-5Lymphedema Pumps/Pneumatic Compressors ....................................................................... 94-19, 94-187Medical Policy

Medical Policy: Where DMERC Medical Policy Does Not Exist ......................................................94-13Medical Policy Important Update ......................................................................................................94-20

Medicare Part B Carrier's Manual: How To Obtain ...............................................................................94-90National K Code Pricing ..........................................................................................................................94-27National Supplier Clearinghouse

NSC Change of Address Notification ...............................................................................................94-29NSC Change of Address Notification Form ......................................................................................94-29

New HCPCS Level III Codes for Enteral Products ...............................................................................94-6-7New Interest Rate Payable on Clean Claims........................................................................................94-181Notice of Transition Delays .....................................................................................................................94-58OBRA 93 Changes .................................................................................................................................94-1-3OBRA 93 Supplemental Plans ...................................................................................................... 94-182-183Ombudsmen Addresses and Their Territories ........................................................................................94-87


- NOTES -

Oral Anticancer Drugs ........................................................................................................................94-60-63PEN Supply and Administration Kits .......................................................................................................94-90Physician Order .........................................................................................................................................94-4Place of Service (POS) ...........................................................................................................................94-85Prescription Before Delivery....................................................................................................................94-71Prior Authorization Process .....................................................................................................................94-88Professional Relations Staff ....................................................................................................................94-86Questions & Answers ........................................................................................ 94-30-32, 94-89, 94-187-188Recategorization of New Wheelchair Codes ............................................................................................94-5Recategorization of Orthotic Seating Systems .....................................................................................94-199Resubmittals vs. Reviews .....................................................................................................................94-180Revised State-By-State Transition Schedule .........................................................................................94-59SADMERC's HCPCS Functions ............................................................................................................94-4-5Service Access ........................................................................................................................................94-89Supplier Advisory Committee ..................................................................................................................94-85Supplier Signature Requirements Reminder ........................................................................................94-180Team Tips ...................................................................................................................................... 94-185-186Telephone Directory .................................................................................................................. 94-53, 94-108Telephone Service ................................................................................................................................94-179Transition Tips ....................................................................................................................................94-72-74Transition Update ..................................................................................................................................94-177Transtracheal Catheters ........................................................................................................................94-183Unique Physician Identification Number (UPIN) Directory: How To Obtain ..........................................94-90Using the OCNA Matrix .................................................................................................94-91-95, 94-191-195Workload Transition Reminder ...............................................................................................................94-19Workshop Series Success ....................................................................................................................94-184

CUMULATIVE INDEX (CONT'D)

Palmetto Government Benefits Administrators DMERC MEDICARE ... · Durable Medical Equipment...

Documents

Transcript of Palmetto Government Benefits Administrators DMERC MEDICARE ... · Durable Medical Equipment...