RA Messages for December 9, 2003

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 WHICH MAY HAVE BEEN INCORRECTLY PAID.

PLEASE MAKE THE FOLLOWING CHANGES TO THE 1/01/02 VERSION OF APPENDIX C:

LABELER COMPANY BEGIN END   
00168 E. FOUGERA AND CO.    01/01/04
52761  GENDERM    01/01/04
53706 DELTA PHARMACEUTICALS, INC    01/01/04
53807  RIJ PHARMACEUTCAL CORPORATION    01/01/04
59746  TRIGEN LABORATORIES, INC     01/01/04
61808   IMIREN PHARMACEUTICALS, INC. 01/01/04   
62338 BAXTER HEALTHCARE CORPORATION    01/01/04
63044    NNODUM CORPORATION    01/01/04
66657 GENTA, INC  01/01/04   
66814 WORLD GEN  01/01/04   
67919 CUBIST PHARMACEUTICALS, INC 01/01/04  
68220  ALAVEN PHARMACEUTICAL, LLCP 01/01/04   

HOME AND COMMUNITY-BASED WAIVER SERVICES

FOR INFORMATION ABOUT HOME AND COMMUNITY-BASED WAIVER SERVICES AS AN 
ALTERNATIVE LONG TERM CARE OPTION, PLEASE CALL 1-800-660-0488.

ATTENTION PROVIDERS

DURING THE LAST WEEK OF SEPTEMBER, SOME CODES FOR PHYSICIAN SERVICES WERE PLACED IN NON-PAY STATUS THROUGH ERROR. CONSEQUENTLY, CLAIMS FOR CODES 36489, 36620, 93503, 62270, ETC. DENIED WITH ERROR EDIT 299. PROVIDERS WILL RECEIVE REIMBURSEMENT FOR THESE SERVICES ON THE RA OF 11-25-03. CALL KANDIS WHITTINGTON AT 225-342-9490 IF YOU HAVE QUESTIONS.

ATTENTION ANESTHESIA PROVIDERS

BEGINNING WITH HIPAA IMPLEMENTATION AND FOR CLAIM DATES OF SERVICE OCTOBER 1, 2003 AND AFTER, ALL ANESTHESIA CLAIMS FOR THE ADMINISTRATION OF ANESTHESIA MUST BE SUBMITTED WITH MINUTES INDICATED IN THE UNITS FIELD. CLAIMS SUBMITTED WITHOUT MINUTES INDICATED ON THE CLAIM FORM WILL BE DENIED WITH ERROR CODE 949-ANESTHESIA MINUTES INVALID OR MISSING. CLAIMS FOR ANESTHESIA SERVICES THAT ARE NOT FOR THE ADMINISTRATION OF ANESTHESIA DO NOT REQUIRE A MODIFIER OR MINUTES. TO AVOID UNNECESSARY CLAIM DENIALS, PLEASE ENSURE THAT YOUR CLAIM FOR THE ADMINISTRATION OF ANESTHESIA INCLUDES THE APPROPRIATE MINUTES.

ATTENTION AMBULANCE PROVIDERS

AS A RESULT OF HIPAA IMPLEMENTATION, AMBULANCE CLAIMS THAT DID NOT HAVE THE NEWLY REQUIRED MODIFIERS WERE INCORRECTLY PAID. THESE CLAIMS SHOULD HAVE DENIED DUE TO THE MISSING MODIFIERS. DHH WILL VOID THESE CLAIMS AND PROVIDER MUST RE-BILL USING THE APPROPRIATE MODIFIERS. THE VOIDS WILL SHOW UP ON THE NEXT RA.