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Archived Medicare Part B Edit Information

This page contains information on the Medicare Point of Sale edit that was added on March 1, 2003 to the Medicaid program claims processing system for pharmacy services.  The edit ensures that Medicare covered drugs are not paid by Medicaid.  Those services, which Kentucky Medicaid recognizes as routinely covered by Medicare, will deny if submitted first to Medicaid.  Please find listed below information pertaining to the implementation and ongoing operation of that edit.

Information pertaining to the implementation and ongoing operation of edit:

List of Medicare Covered Drugs and Billing Codes for Medicare

November 22, 2002 Provider Letter - This letter outlines the process for becoming a Medicare Provider.

February 6, 2003 Provider Letter - This letter describes the implementation of the Medicare POS Edit on March 1, 2003.

MAP-20C Form - This form is to be used to bill Medicaid for drugs not covered by Medicare - you must include your EOB showing a denial of coverage to ensure a payment.

MAP-82101 Form - This form is to be used to override the Medicare Part B Edit through the Prior Authorization Unit - you must include your EOB showing a denial of coverage to ensure payment.

 

Last Updated 7/3/2013
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