RA Messages for December 21, 2004

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ATTENTION ALL MEDICAID PROVIDERS

DUE TO NUMEROUS PROBLEMS ENCOUNTERED IN THE PAST, EFFECTIVE JANUARY 1, 2005, U.S. MAIL IS NO LONGER AN ACCEPTABLE METHOD OF REQUESTING/ISSUING COMMUNITYCARE REFERRALS/AUTHORIZATIONS. HOSPITAL TO PCP POST- AUTHORIZATIONS SHALL BE REQUESTED AND ISSUED(OR DENIED WHEN APPROPRIATE) VIA FAX OR ELECTRONIC REFERRAL AUTHORIZATION SYSTEM (ERA). WHEN REFERRING A COMMUNITYCARE RECIPIENT FOR SPECIALTY CARE, THE PCP MAY ELECT TO SEND THE REFERRAL/AUTHORIZATION WITH THE RECIPIENT, OR FAX IT TO THE OTHER PHYSICIAN. ANY QUESTIONS REGARDING THIS POLICY SHOULD BE DIRECTED TO THE COMMUNITYCARE PROGRAM OFFICE AT (225)342-4810. 

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ATTENTION DENTAL PROVIDERS

POLICY CLARIFICATION REGARDING PROCEDURE CODE D5650 PROCEDURE CODE D5650 (ADD TOOTH TO EXISTING PARTIAL DENTURE) REMAINS AS A REIMBURSABLE SERVICE IN THE EPSDT DENTAL AND ADULT DENTURE PROGRAMS. THIS PROCEDURE CODE WAS INADVERTANTLY REMOVED FROM THE EPSDT DENTAL PROGRAM FEE SCHEDULE EFFECTIVE 9/1/04. SHOULD YOU HAVE ANY QUESTIONS, YOU MAY CONTACT THE MEDICAID DENTAL UNIT BY CALLING 504-619-8589.

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ATTENTION ALL PROVIDERS

EFFECTIVE 12/13/04, WHEN A CLAIM DENIES FOR OTHER INSURANCE COVERAGE, ALL IDENTIFIED INSURANCE COVERAGE EFFECTIVE ON THE DATE OF SERVICE WILL APPEAR ON THE TPL REPORT (TPL DENIED CLAIMS NOTIFICATION LIST - CP-O-25) THAT ACCOMPANIES THE WEEKLY REMITTANCE ADVICE INDICATING THE CLAIM DENIAL. WE BELIEVE THIS CHANGE WILL ASSIST YOU WITH BILLING PRIMARY INSURANCE CARRIERS (MEDICARE AND PRIVATE INSURANCE) PRIOR TO BILLING MEDICAID FOR SERVICES. 

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ATTENTION ALL PROVIDERS

ALL OF THE FALL 2004 TRAINING PACKETS CONTAINED AN INCORRECT TELEPHONE NUMBER UNDER THE LISTING "ADDITIONAL NUMBERS FOR PROVIDER ASSISTANCE." THE CORRECT PHONE NUMBER FOR THE KIDMED RECIPIENT HOTLINE IS 800-259-4444. PLEASE LOCATE THIS INFORMATION IN YOUR INDIVIDUAL TRAINING PACKETS UNDER THE PROVIDER ASSISTANCE SECTION OF THE PACKET, AND MAKE THIS NEEDED CORRECTION. 

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ATTENTION HOSPITAL PROVIDERS

THE PROPOSED EFFECTIVE DATE FOR THE CHANGE TO SPLIT MOTHER/BABY CLAIMS FOR PROCESSING HAS BEEN DELAYED UNTIL 2/1/05. PROVIDERS ARE ASKED TO BEGIN SPLITTING CLAIMS EFFECTIVE WITH DATES OF SERVICE 2/1/05. THE SYSTEM EDIT WILL BE AN EDUCATIONAL EDIT DURING THE MONTHS OF FEBRUARY AND MARCH, INFORMING PROVIDERS THAT THE CLAIM MUST BE SPLIT. THE EDIT WILL BECOME A DENIAL EDIT BEGINNING 4/1/05. AT THAT TIME THESE CLAIMS MUST BE SUBMITTED WITH A VALID MEDICAID RECIPIENT ID NUMBER FOR BOTH THE MOTHER'S CLAIM AND THE BABY'S CLAIM, OR THE CLAIMS WILL DENY. PLEASE TAKE THE NECESSARY STEPS TO ENSURE THAT YOU ARE OBTAINING VALID RECIPIENT ID NUMBERS FOR BOTH MOTHER AND BABY PRIOR TO SUBMITTING THESE CLAIMS.