If you are unsure about the coverage of a drug product, please contact the PBM help desk at 1-800-648-0790. Please file adjustments for claims that may have been incorrectly paid. Only those products of the manufacturers which participate in the Federal Rebate Program will be covered by the...
5,6 Medicaid is a major health insurer for adults with Down syndrome.7 With rare exception, all adults with Down syndrome are automatically eligible for Medicaid after enrolling in Social Security Insurance.8 Adults with Down syndrome could receive employer-based insurance coverage; however, ...
IN THESE CASES, THE ADMISSION DATE SHOULD BE THE DATE THE OUTPATIENT SERVICES WERE PROVIDED ADDITIONALLY, PSYCHIATRIC PATIENTS ADMITTED THROUGH THE EMERGENCY ROOM SHOULD HAVE THE ER CHARGES ROLLED INTO THE INPATIENT PSYCHIATRIC BILL (EVEN WHEN THE FACILITY HAS SEPARATE PROVIDER NUMBERS FOR ACUTE AND ...
NYS prohibits plans from performing utilization management or denying coverage for the first 14 days of inpatient treatment; this policy elicited mixed reactions among stakeholders. For example, one plan administrator believed that prohibiting plans from utilization management was detrimental as plan ...
Nearly 12% of Medicare patients who receive inpatient rehabilitation following discharge from acute-care hospitalization are readmitted to the hospital within 30 days after discharge from the rehabilitation facility, according to a study in the Feb. 12 issue of the Journal...