RA Messages for September 1, 2009
PHARMACY
PROVIDERS, PLEASE NOTE!!!
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 Medicaid program. Participation may be
verified in Appendix C, available at
www.lamedicaid.com.
ATTENTION
MULTI-SYSTEMIC THERAPY (MST) PROVIDERS
We have made a
change to claims processing for Multi-Systemic Therapy services to allow claims
to be processed on the same date of service if the Place of Treatment/Place of
Service is different. Claims that were denied for error 689 (MHR SERVICES
ALREADY PAID FOR THIS DATE OF SERVICE) for MST services with a different Place
of Treatment are being systematically recycled on the 8/18/09 RA. No provider
action is necessary.
ATTENTION
HOSPITAL PROVIDERSS
Review of claims
related to the NDC implementation has revealed that some providers are
submitting NDC data with inappropriate revenue codes.Effective August 31, 2009,
for the RA of September 8, 2009, a new edit
will be implemented to deny outpatient hospital claim lines when NDC
data is reported with a revenue code that is not in the 250-259 or
630-639 range. The new edit is 545, Revenue Code Invalid for Reporting
NDC Info. Hospital providers must ensure that NDC data is reported
with correct revenue codes in order to eliminate unnecessary denials.
ATTENTION FREE-STANDING ESRD FACILITIES
SYSTEMATIC CLAIMS ADJUSTMENT
A systematic adjustment of Free-Standing ESRD Facility claims will occur
on the RA of August 25, 2009, for claims that were paid incorrectly as a
result of the delay in implementation and/or a programmatic error in
payment calculation when the rate reductions were implemented for dates
of service on or after February 26, 2009. These reductions were part of
the 2009 Medicaid budget cuts. No action is necessary by providers. A
minor increase or decrease in payments will be noted as a result of
these adjustments.
ATTENTION
PROFESSIONAL SERVICES PROVIDERS
INTRAVASCULAR STENTS: DIAGNOSIS EDIT RESTRICTION DISCONTINUED
Effective
with date of service 7/1/07 forward, diagnosis edit restrictions for
transcatheter placement of intravascular stents (current CPT codes
37205-37208) have been discontinued. These CPT codes are no longer
limited to the primary or secondary diagnosis codes 440.21, 440.22,
444.81, or 572.3. Providers can now resubmit claims that previously
denied for edit 251 (Denied Due to Diagnosis). The Department will
approve timely filing overrides for claims that denied for these
diagnosis restrictions as long as they were originally submitted within
the 1-year filing limit. Claims over the 1-year filing limit may be
submitted through normal channels with the RA page indicating proof of
timely filing attached. Claims over the 2-year filing limit should be
submitted to Unisys Provider Relations with the RA indicating proof of
the 1-year filing limit and a letter requesting that the claim(s) be
overridden for the 2-year limit and reprocessed for payment.