RA Messages for November 9, 2004

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 APPENDIX A: 

DRUG DOSAGE  STRGTH MAC EFF DATE 
GRIEOFULVIN ULTRMICROSIZE TABLET 125MG OFF MAC 10/01/04

    PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

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.

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. 

ATTENTION SCHOOL-BASED HEALTH CENTER PROVIDERS

SCHOOL-BASED HEALTH CENTER CLAIMS THAT INCORRECTLY DENIED FOR TIMELY FILING ERRORS ARE BEING RECYCLED, AND THIS CORRECTION IS REFLECTED ON THE REMITTANCE OF 11-9-04. 

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.