RA Messages for November 25, 2008
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.
Detailed FUL changes eff. 11/28/08 are posted on
www.lamedicaid.com.
NOTICE TO PROVIDERS OF HOSPICE
SERVICES
Policy Clarification
- Revocations must be submitted to the Hospice Program within 3 working
days of the revocation. Any revocation submitted after the 3 day limit
will become effective on the date of receipt.
ATTENTION ALL PROVIDERS
Effective with dates of
service October 1, 2008, forward, the 2009 ICD-9 Disease and Procedure
Classification Code Updates have been added to our files. Claims that
have denied for invalid diagnosis/procedure codes prior to the loading
of the 2009 ICD-9 data will be recycled and no action is required by the
provider. Providers will be informed via RA message when the recycle
will take place.
ATTENTION PROVIDERS BILLING TPL
CLAIMS
Effective with date of
processing November 10, 2008, the logic changes for processing TPL
claims for Home Health, LTC, ADHC, and Dental providers are now in place
and effective for all TPL claims. These providers may also begin
submitting TPL claims electronically. Logic changes for the
Rehabilitation Center 102 paper claim form are also effective for this
processing date. Changes for EDI claims submitted by Rehabilitation
Centers and other providers submitting EDI claims with the 837P were
effective in March of this year. Additionally, TPL claims claims paid
using the new logic can now be adjusted - either electronically or hard
copy. Updates will soon be made to the EDI Companion Guides as
appropriate. TPL changes for ambulance transportation claims will be
forthcoming. Please watch future RAs for this transition. Questions
concerning these changes may be addressed to Unisys Provider Relations
at (800) 473-2783 for general questions or the Unisys EDI Help Desk at
(225) 216-6303 for technical questions concerning EDI billing.
ATTENTION KIDMED PROVIDERS
Effective with date of
processing Monday, December 1, 2008, the KIDMED Claims Processing
Subsystem will be merged into the Medicaid Claims Processing System
which processes all other Medicaid claims. This merge will be beneficial
for KIDMED providers and should remove many of the current problem areas
related to processing KIDMED claims through a separate subsystem prior
to the claims data entering the regular Medicaid subsytem for
processing. Current KIDMED claims reports will also be revised or
eliminated. Detailed provider notices concerning this transition are
being posted on the Home page and the New Medicaid Information link of
the LA Medicaid web site, www.lamedicaid.com. Please visit the web site
to obtain the details of this important transition that will affect you.
After reviewing these notices, any questions may be directed
appropriately to Unisys Provider Relations at (800) 473-2783, the Unisys
EDI Helpdesk at (225) 216-6303, or the Unisys Web Technical Support Team
at (877) 598-8753.
ATTENTION HOSPITAL PROVIDERS
As reported earlier, we had
a system problem that occurred on outpatient claims processed in the
checkwrites dated 09/02/08 and 09/09/08. This problem caused the Units
and Billed Charge fields on these claims to be expanded by one digit,
and the claims were priced and paid accordingly. We have identified
additional claims needing correction and will process systematic
adjustments for the erroneously processed claims. No action is required
on your part. Some of these claims were overpaid which necessitates a
recoupment from the provider. Also, some of the claims will be adjusted
to correct the incorrect Units or Billed Charges only, and there will be
no adjustment/difference in the Medicaid paid amount for these claims.
The systematic adjustments will be displayed in the Adjustment
Claims/Previously Paid Claims sections of your remittance advice dated
11/25/08. We apologize for any inconvenience this error may have caused.
Contact Unisys Provider Relations at (800) 473-2783 or (225) 924-5040 if
you have questions.
The 2008 Holiday EDI Processing
Schedule will be as follows
Tuesday 11/25/08 4:30PM -
KIDMED deadline
Wednesday 11/26/08 10:00AM deadline - all claims (with exception of
KIDMED and LTC)
Wednesday 12/24/08 10:00AM deadline - all claims (with exception of LTC)
Wednesday 12/31/08 10:00AM deadline - all claims (with exception of LTC)