RA Messages for December 28, 2004

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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.

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TO ALL MEDICAID PROVIDERS THAT ADMINISTER PEDIATRIC FLU VACCINE

CMS HAS ISSUED THE FOLLOWING CLEARANCE FOR HIGH PRIORITY VFC ELIGIBLE CHILDREN REGARDING THE PEDIATRIC INFLUENZA VACCINE. IF A MEDICAID PROVIDER DOES NOT HAVE VFC PEDIATRIC INFLUENZA VACCINE ON HAND TO VACCINATE A  HIGH PRIORITY MEDICAID CHILD, THE PROVIDER SHOULD USE PEDIATRIC INFLUENZA VACCINE FROM PRIVATE STOCK, IF AVAILABLE. THE PROVIDER SHOULD NOT TURN AWAY, REFER, OR RESCHEDULE A HIGH PRIORITY CHILD IF VACCINE IS AVAILABLE. THE LA OPH/VFC PROGRAM HAS AN ADEQUATE SUPPLY OF PEDIATRIC INFLUENZA VACCINE. FOR AVAILABILITY INFORMATION OR TO ORDER VFC PEDIATRIC INFLUENZA VACCINE, CONTACT THE OPH/VFC OFFICE AT 504-483-1900.FOR A DEFINITION OF HIGH PRIORITY CHILDREN GO TO THE CDC WEBSITE AT:
HTTP://WWW.CDC.GOV/NIP/VFC/ACIP_RESOLUTIONS/1004-1FLU.PDF

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ATTENTION PROFESSIONAL SERVICE PROVIDERS

BEGINNING12/21/04, EFFECTIVE WITH DATES OF SERVICE 1/1/04 LA MEDICAID WILL ACCEPT CLAIMS WITH MODIFIER 63 TO INDICATE PROCEDURES PERFORMED ON NEONATES AND INFANTS UP TO A PRESENT BODY WEIGHT OF 4KG THAT INVOLVE SIGNIFICANTLY INCREASED COMPLEXITY AND PHYSICIAN WORK. THESE SERVICES WILL BE REIMBURSED AT 125% OF THE FEE ON FILE. THESE CLAIMS ARE SUBJECT TO POST PAY REVIEW AND DOCUMENTATION SHOULD INCLUDE THE RECIPIENT'S WEIGHT AT THE TIME OF THE PROCEDURE. PROVIDER SHOULD RESUBMIT PREVIOUSLY DENIED CLAIMS.