RA Messages for November 16, 2004

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ATTENTION PROVIDERS SUBMITTING PROPRIETARY ELECTRONIC CLAIMS

IT IS IMPERATIVE THAT ALL EMC PROPRIETARY ELECTRONIC CLAIMS SUBMISSIONS 
CONVERT TO HIPAA COMPLIANT FORMATS AS QUICKLY AS POSSIBLE. PLEASE 
CONTACT YOUR VENDOR, BILLING AGENT OR CLEARINGHOUSE TO ENSURE THAT THEY 
ARE COMPLETING ALL NECESSARY TESTING TO ALLOW UNINTERRUPTED SUBMISSION 
OF ELECTRONIC CLAIMS. SPECIFIC DEADLINES FOR EDI TRANSACTIONS ARE AS 
FOLLOWS: INPATIENT/OUTPATIENT (UB92) - OCTOBER 31, 2004; DME/AMBULANCE 
TRANSPORTATION - DECEMBER 31, 2004; PROFESSIONAL - MARCH 31, 2005; 
OTHER PROGRAMS - TBD. PROPRIETARY CLAIMS SUBMITTED AFTER APPLICABLE 
DEADLINES WILL NOT BE PROCESSED. 

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ATTENTION PROFESSIONAL SERVICES PROVIDERS

PAGE 50 OF THE FALL 2004 PROFESSIONAL SERVICES TRAINING PACKET LISTED 
THE REIMBURSEMENT FOR PROCEDURES WITH MODIFIER 63 TO BE 150% OF THE FEE 
ON FILE. THIS SHOULD READ 125% OF THE FEE ON FILE. IF YOU HAVE ALREADY 
ATTENDED TRAINING AND OBTAINED THE PACKET, PROFESSIONAL SERVICES 
TRAINING - MEDICAID ISSUES FOR 2004 (FALL ISSUE) PLEASE MAKE THIS 
CORRECTION. 

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ATTENTION ALL DENTAL PROVIDERS

IN THE NEAR FUTURE, MEDICAID WILL AUTOMATICALLY RECYCLE CLAIMS FOR PROCEDURE CODES WHICH RECEIVED AN EXPLANATION OF BENEFITS (EOB) CODE 775 (PAYMENT CUTBACK SAME TOOTH.) THE RECYCLED CLAIMS WILL APPEAR ON YOUR RA. EFFECTIVE ON THE DATE OF THE RECYCLE AND AFTER, ALL CLAIMS FOR PAYMENT THAT DENY WITH CODE 515 (OVERRIDE REQUIRED-SEND TO DENTAL PA UNIT), SHOULD BE BATCHED AND SUBMITTED TO THE MEDICAID DENTAL PRIOR AUTHORIZATION UNIT ALONG WITH A COVER LETTER REQUESTING AN OVERRIDE OF THE DENIAL CODE 515. MEDICAID WILL CONSIDER YOUR REQUEST AND WILL PROCESS THE CLAIM OVERRIDE, IF APPROVED, AS SOON AS POSSIBLE. ONCE PROCESSED THE TRANSACTION WILL APPEAR ON YOUR RA. PLEASE CONTACT THE MEDICAID DENTAL PRIOR AUTHORIZATION UNIT WITH ANY QUESTIONS BY CALLING 504-619-8589.

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NOTICE TO DENTAL PROVIDERS - NEW DENTAL CLAIM FORM REQUIREMENTS

EFFECTIVE 1/1/2005, THE 2002 AMERICAN DENTAL ASSOCIATION CLAIM FORM AND THE 2002, 2004 AMERICAN DENTAL ASSOCIATION CLAIM FORM WILL BECOME THE ONLY HARDCOPY DENTAL CLAIM FORMS ACCEPTED FOR MEDICAID PRIOR AUTHORIZATION AND REIMBURSEMENT OF SERVICES PROVIDED IN THE EPSDT, EDSPW, AND ADULT DENTURE PROGRAMS. FURTHER INFORMATION REGARDING THIS REQUIREMENT WILL BE PROVIDED IN THE SEPT/OCT 2004 ISSUE OF THE PROVIDER UPDATE AND IS CURRENTLY AVAILABLE ON THE WWW.LAMEDICAID.COM WEBSITE. SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS AT (225) 924-5040 OR (800) 473-2783 OR THE MEDICAID DENTAL PRIOR AUTHORIZATION UNIT AT (504) 619-8589.