RA Messages for October 30, 2001

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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.

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PLEASE MAKE THE FOLLOWING CHANGES TO THE 12/9/00 VERSION OF APPENDIX C:

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

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ATTENTION PHARMACY PROVIDERS

IF YOU ARE AN INDEPENDENT OR CHAIN PHARMACY, YOU MAY RECEIVE A VERY IMPORTANT QUESTIONNAIRE WITHIN THE NEXT FEW DAYS.  PLEASE TAKE A FEW MOMENTS TO COMPLETE IT AND RETURN TO US IN THE SELF-ADDRESSED ENVELOPE YOU WILL RECEIVE.  YOUR RESPONSE IS VITAL TO OUR EFFORTS TO CONTINUE THE "PAY AND CHASE" METHOD OF PHARMACY BILLING IN LOUISIANA AS OPPOSED TO THE COST-AVOIDANCE METHOD WHICH REQUIRES PHARMACIES TO BILL PRIVATE INSURANCE CARRIERS FIRST.  YOUR HELP IN THIS MATTER WILL BE GREATLY APPRECIATED.  PLEASE NOTE THAT THE CORRECT RETURN DATE IS NOVEMBER 5TH AND DISREGARD THE OCTOBER 5TH DATE SHOWN ON THE SURVEY.

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NOTICE TO KIDMED PROVIDERS

EPSDT CONSULT CODES (X0180-X0182, X0187-X0189) ARE TO BE SPECIFIC TO AN INDIVIDUAL CHILD'S NEEDS.  DOCUMENTATION SHOULD BE PRESENT AS TO THE NEED FOR THE CONSULT FOR THAT PARTICULAR CHILD.  OUTCOMES FOR THE CONSULTS ARE TO BE DOCUMENTED AS WELL AS REFERRALS TO APPROPRIATE RESOURCES FOR THOSE CONDITIONS THAT MIGHT REQUIRE FURTHER ATTENTION.  CONSULTS ARE TO BE FACE-T0-FACE CONTACT IN ONE-ON-ONE SESSION.  CONSULT CODES ARE NOT TO BE USED FOR ONGOING TREATMENT.  GROUP SESSIONS ARE NOT ALLOWED AND MULTIPLE UNITS MAY NOT BE BILLED FOR THE SAME CONTACT.

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NOTICE TO CERTIFIED NURSE PRACTITIONERS

EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2001, THE FOLLOWING CPT CODE
WILL BE ADDED TO THE LIST OF CODES PAYABLE TO CERTIFIED NURSE PRACTITIONERS - 31515 - LARYNOGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION. 

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NOTICE TO ALL HEMODIALYSIS CENTERS

TO FACILITATE MEDICAID PAYMENTS AT THE MEDICARE RATE, ALL END STAGE 
RENAL DISEASE FACILITIES MUST SUBMIT THEIR CURRENT RATE ASSIGNED BY 
MEDICARE TO THE DEPARTMENT OF HEALTH AND HOSPITALS BY OCTOBER 25, 2001. 
THE COMPOSITE RATES MAY BE MAILED TO THE ATTENTION OF GAIL WILLIAMS, BIN
24, P.O. BOX 91030, BATON ROUGE, LA 70821-9103, OR FAXED TO GAIL'S 
ATTENTION AT 225-342-1411. 

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NOTICE TO KIDMED PROVIDERS

THE VACCINE ADMINISTRATION FEE ($9.45) INCLUDES MONITORING FOR REACTIONS AND THE ROUTINE TASKS ASSOCIATED WITH VACCINE ADMINISTRATION. THERE SHOULD NOT BE A NEED TO BILL A NURSE CONSULT OR AN OFFICE VISIT IF THE CHILD IS COMING IN TO GET ONLY AN IMMUNIZATION. PLEASE BE AWARE THAT THE ADMINISTRATION OF AN INJECTION IS INCLUDED IN THE OFFICE VISIT FEE.  

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

THE FEES FOR THE FOLLOWING CPT CODES WILL BE INCREASED EFFECTIVE WITH 
DATE OF SERVICE NOVEMBER 1, 2001. 
96045-CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL,UP TO AND INCLUDING 7 LESIONS - $55.48. 
96406-CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL, MORE THAN 7 LESIONS-$79.34. 
96408-CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS, PUSH TECHNIQUE-$27.62. 
96410-CHEMOTHERAPY ADMINISTRATION, INFUSION TECHNIQUE, UP TO ONE HOUR-$44.08. 96414-CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS, INFUSION TECHNIQUE, MORE THAN EIGHT HOURS-$38.18. 
96440-CHEMOTHERAPY ADMINISTRATION INTO PLEURAL CAVITY, REQUIRING AND INCLUDING
THORACENTESIS-$240.38. 
96445-CHEMOTHERAPY ADMINISTRATION INTO PERITONEAL CAVITY, REQUIRING AND INCLUDING PERITONECENTESIS-$242.04. 
96542-CHEMO THERAPY INJECTION, SUBARACHNOID OR INTRAVENTRICULAR VIA SUBCUTANEOUS 
RESERVOIR, SINGLE OR MULTIPLE AGENTS - $132.47. 

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NOTICE TO ALL PROVIDERS

THIS IS TO INFORM ALL PROVIDERS THAT EFFECTIVE MARCH 1, 2002, LOUISIANA MEDICAID WILL EXPAND THE COMMUNITYCARE PROGRAM TO INCLUDE LIVINGSTON, ST HELENA, ST. TAMMANY, TANGIPAHOA, AND WASHINGTON PARISHES. MEDICAID RECIPIENTS IN THESE PARISHES WILL RECEIVE LETTERS EARLY IN FEBRUARY ADVISING THEM TO CHOOSE A PRIMARY CARE PROVIDER IN THEIR PARISH OR A CONTIGUOUS PARISH. THESE LETTERS WILL INCLUDE A LIST OF COMMUNITYCARE ENROLLED PROVIDERS IN THE RECIPIENT'S PARISH. IF RECIPIENTS DO NOT CHOOSE A PROVIDER BY THE DESIGNATED DATE THEY WILL BE AUTO-ASSIGNED BY THE STATE. PROVIDERS WHO ARE NOT ENROLLED AS A COMMUNITY CARE PROVIDER BY FEBRUARY 15, 2002
WILL NOT BE OFFERED AS A CHOICE. ANY MEDICAID PRIMARY CARE PROVIDER (FAMILY PRACTICE, GENERAL PRACTICE, INTERNAL MEDICINE, OB, PEDIATRICIAN) IN THE ABOVE LISTED PARISHES WHO WISHES TO ENROLL AS A COMMUNITYCARE PRIMARY CARE PROVIDER SHOULD BEGIN THE ENROLLMENT PROCESS NOW, IN ORDER TO BE INCLUDED AS AN AVAILABLE COMMUNITYCARE PROVIDER ON THE LETTERS WHICH RECIPIENTS WILL RECEIVE IN FEBRUARY. AFTER MARCH 1, 2002, PROVIDERS IN THESE PARISHES WHO DO NOT ENROLL IN COMMUNITYCARE WILL NEED TO OBTAIN A REFERRAL FROM THE COMMUNITYCARE PCP IN ORDER TO BILL FOR SERVICES TO MOST MEDICAID RECIPIENTS. ENROLLMENT PACKETS FOR COMMUNITYCARE MAY BE OBTAINED BY CONTACTING UNISYS PROVIDER RELATIONS AT 800-473-2783. QUESTIONS MAY BE DIRECTED TO PROVIDER RELATIONS AT THAT NUMBER, OR TO THE COMMUNITYCARE PROGRAM OFFICE AT 225-342-1304.