STATE OF NEW YORK

DEPARTMENT OF HEALTH

eMedNY

Prospective Drug Utilization Review/

Electronic Claims Capture and Adjudication

ProDUR/ECCA Provider Manual

July 26, 2006

Version 1.18

TABLE OF CONTENTS

Section

1.0 INTRODUCTION 1.0.1

2.0 GENERAL INFORMATION 2.0.1

2.1 Access Methods. 2.1.1

2.2 Card Swipe. 2.2.1

2.3 Response Formats 2.3.1

2.4 Electronic Claims Capture and Adjudication (ECCA) 2.4.1

2.5 Medicare and Third Party Claims 2.5.1

Chart 1 – Recipient with Coverage Codes K, M, O or ALL on file. 2.5.3

Chart 2 - Recipient without Coverage Codes on file. 2.5.4

2.6 Rebills/Adjustment Information. 2.6.1

2.7 Refills Information 2.7.1

2.8 Health Care Financing Administration Common Procedure Coding System (HCPCS) 2.8.1

2.9 HCPCS Quantities 2.9.1

2.10 Dispensing Validation System 2.10.1

2.11 Prior Auth Type Code and Prior Auth Number Submitted. 2.11.1

2.12 Temporary Medicaid Authorizations. 2.12.