 | Term | Definition |
| |
mac or maic |
maximum allowable ingredient cost |
| |
+ |
frequency of billing restriction |
| |
# |
quantity restriction |
| |
* |
code 1 restriction. use of drug is restricted for specific diagnosis only. if the code 1 restriction is met, place an X or Y int the code 1 box ont the claim form |
| |
Treatment Authorization Request (TAR) |
this form is for drugs that are not covered by Medi- Cal |
| |
Explanation of Benefits (EOB) |
the State controls office issues and mails the Medi- Cal checks to the pharmacy with an explanation of adjustments, payments suspension and denials. |
| |
Resubmission Turnaround Document (RTD) |
it will be produced whenever a Medi- Cal Claim form has one or more errors in it |
| |
tetrahydrozoline HCI (Ophthalmic Decogestants) |
Visine |
| |
sulfacetamide (Ophthalmic Antibiotics) |
Bleph- 10 or Sodium Sulamyd |
| |
neomycin + dexamethasone (Anti- Inflammatories) |
Neo- decadron |
| |
chloramphenicol (Ophthalmic Antibiotics) |
Chloromycetin |
| |
allopurinol (Drugs for Gout) |
Zyloprim |
| |
timolol (Agents for Glaucoma) |
Timoptic |
| |
phenylephrine (Ophthalmic Decongestants) |
Neo- sinephrine or Prefrin |
| |
sumatriptan |
Imitrex |
| |
pilocarpine (Agents for Glaucoma) |
Isopto Carpine or Pilocar |
| |
neomycin + polymyxin B + prednisolone + dexamethasone (Anti- Inflammatories: combination steroids & antibiotic products) |
Maxitrol |
| |
probenecid (Drugs for Gout) |
Benemid |
| |
tobramycin (Ophthalmic Antibiotics) |
Tobrex |
| |
Health Maintenance Organization (HMO) |
designed to provide a comprehensive health service with quality assurance and long- term economy |
| |
naphazoline (Ophthalmic Decongestants) |
Naphron, Vasocon or Clear Eyes |
| |
tetracycline (Ophthalmic Antibiotics) |
Acromycin |
| |
gentamicin (Ophthalmic Antibiotics) |
Garamycin or Genoptic |
| |
neomycin (Ophthalmic Antibiotics) |
Gramicidin or Neospirin |
| |
erythromycin (Ophthalmic Antibiotics) |
Ilotycin |
| |
prednisolone (Anti- Inflammatories: steroids) |
Pred Mild or Pred- Forte |
| |
dexamethasone (Anti- Inflammatories: steroids) |
Decadron |
| |
sulfacetamide + prednisolone (Anti- Inflmmatories: combination steroids) |
Metimyd or Blephamide |
| |
echothiophate (Agents for Glaucoma) |
Phospholine Idodide |
| |
pilocarpine + epinephrine (Agents for Glaucoma) |
E- Pilo- 1, P1E1, E- 5, Pilo- 2 or P2E1 |
| |
olopatadine (Ophthalmic Antihistamine) |
Patanol |
| |
colchicine (Drugs for Gout) |
no trade name |
| |
probenecid + colchicine (Drugs for Gout) |
Col- Benemid |
| |
Artificial Tears |
Isopto Tears, Tearisol and Adsorbotears |
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