Subject Prior Authorization, NPI and Web Portal

							                                  Provider Communication
 Subject:      Prior Authorization, NPI and Web Portal       Priority:       High
               Registration Information

 Date:         January 23, 2008                              Message ID:     ACSBNR01232008_2


Dear Pharmacy Provider:

Prior Authorization Process and Criteria
The Georgia Department of Community Health is in the process of providing conditions for coverage
for medications requiring prior authorization in the Georgia Medicaid program.
To view the conditions for coverage and also access helpful information go to the following:
www.dch.georgia.gov >Home > Providers > Pharmacy > Prior Authorization Process and Criteria.
There is also a proton pump inhibitor form listed that may be faxed in for PPI PA requests.

Flonase Update
Effective 2/1/2008, FLONASE (brand name) will be NON-PREFERRED and fluticasone (generic) will
be PREFERRED.


Pharmacy NPI Implementation
SXC is now accepting and encouraging the use of the pharmacy National Provider Identifier (NPI) for
Georgia Medicaid Fee-for-Service claims. Presently, the pharmacy may submit the pharmacy NPI OR
NCPDP number OR the GA Medicaid ID.
Please submit the correct ID qualifier in field 202-B2 based on the Service Provider ID submitted in
field 201-B:
    01- National Provider ID (NPI)
    05- Medicaid ID
    07- NCPDP Provider ID

This is a transition phase to accepting only the pharmacy NPI. I encourage you to begin submitting the
pharmacy NPI now. At this time, the prescriber NPI is not accepted. Future banner messages will have
more information on mandatory implementation of both the Prescriber and Pharmacy Provider NPI. If
you have questions, please contact the SXC Technical Call Center at 1-866-525-5826.

SXC Web Portal Registration
         •   Register now to access important GA Medicaid information via SXC Web portal
         •   Information available:
             – Weekly Banners
             – Medicaid FFS medication history
             – Remittance Summaries
             – Preferred Drug List
Georgia Department of Community Health                                                           ACS
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           –   Prior Authorization Guide
           –   Part II Policy & Procedures Manual

The Registration Form can be accessed at URL: https://ga.providerportal.sxc.com
      • Fax or email registration form to:
          Fax: (770)776-2050 or Email: gaportal@sxc.com

You will be contacted via email with your user name/password once the registration form is processed.

We thank you for your continued service and participation in the Georgia Medicaid & Peach Care for
Kids Programs. Please share this information with appropriate staff. If you are the corporate office of a
chain pharmacy, please provide this information to each of your stores located in Georgia.

Division of Medical Assistance
Pharmacy Services Unit
404-656-4044




Georgia Department of Community Health                                                              ACS
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