RA Messages for October 24, 2000

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 MAKE THE FOLLOWING CHANGES TO THE 5/15/00 VERSION OF APPENDIX A:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

NOTICE TO AUDIOLOGISTS AND PHYSICIANS

THE LOUISIANA MEDICAID PROGRAM RECEIVED CLARIFICATION FROM THE LOUISIANA BOARD OF EXAMINERS FOR SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY THAT CPT CODE 92568 AND CPT CODE 92567 ARE NO LONGER ONE SERVICE BUT TWO SEPARATE SERVICES WHICH ARE NOT INCLUSIVE OF ONE ANOTHER.  WE ARE THEREFORE REVISING OUR POLICY EFFECTIVE OCTOBER 1, 2000 TO REFLECT THIS.

NOTICE TO PHYSICIAN'S BILLING CLERKS

WE WOULD LIKE TO CLARIFY INFORMATION GIVEN BY THIS OFFICE ON SEPTEMBER 25, 2000 ABOUT THE REMITTANCE ADVICE DATED SEPTEMBER 20, 2000 WHICH LISTS THE CLAIMS ON WHICH RECOUPMENTS ARE BEING MADE.

SOME INACCURATE INFORMATION WAS GIVEN DURING THOSE PHONE CONVERSATIONS.  YOU WERE TOLD THAT 7% LESS THAN OFFSET AMOUNT OF $1.48 WOULD BE RECOUPED ON EACH CLAIM.  THE TRUE AMOUNT BEING RECOUPED IS 7% LESS.0534.  THIS FORMULA APPLIES TO RECOUPMENTS ON STRAIGHT MEDICAID CLAIMS, ONLY.

RECOUPMENTS ON PROFESSIONAL CROSS-OVER CLAIMS MAY TOTAL MORE OR LESS THAN 7%.  NO OFFSET AMOUNT SUCH AS .0534 IS BEING APPLIED TO THESE CLAIMS.

PLEASE NOTATE YOUR RECORDS ACCORDINGLY.  WE APOLOGIZE FOR ANY CONFUSION OUR INCORRECT INFORMATION MAY HAVE CAUSED.