RA Messages for November 20, 2001
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.
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.
NOTICE TO PROVIDERS OF PROFESSIONAL
SERVICES
CPT CODE 90508 (CATHETER PLACEMENT IN CORONARY ARTERY(S), ARTERIAL
CORONARY CONDUIT(S), AND/OR VENOUS CORONARY BYPASS GRAFT(S) FOR CORONARY ANGIOGRAPHY WITHOUT CONCOMITANT LEFT HEART CATHETERIZATION) SHOULD BE
INCLUDED IN THE PERFORMANCE OF CPT CODE 92980 (TRANSCATHETER PLACEMENT OF INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITHOUT OTHER
THERAPEUTIC INTERVENTION, ANY METHOD; SINGLE VESSEL). THE ONLY TIME BOTH PROCEDURES MAY JUSTIFIABLY BE BILLED ON THE SAME DATE OF SERVICE FOR
THE SAME RECIPIENT IS WHEN THE PATIENT EXPERIENCES CHEST PAIN AFTER
PLACEMENT AND THE POSSIBILITY EXISTS THAT THE STENT HAS CLOSED. IN THESE CASES, THE PROVIDER MUST REQUEST THE CLAIM BE RECONSIDERED FOR PAYMENT,
AS EDITS WILL SOON BE PLACED IN THE SYSTEM TO DENY CODE 90508 IF THERE IS ALREADY A PAID CLAIM FOR CODE 92982, 92995, OR 92980 IN HISTORY FOR
THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT. LIKEWISE, A CLAIM FOR 92980, 92982, AND 92995 WILL DENY IF THERE IS A PAID 90508 IN HISTORY.