RA Messages for January 11, 2005

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 APPENDIX C:  

LABELER COMPANY BEGIN  END 
54129 BAXTER HEALTHCARE     04/01/05
65779 THE F. DAHMEN COMPANY    04/01/05

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

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

ATTENTION NURSE PRACTITIONERS/CLINICAL NURSE SPECIALISTS

1. PROGRAMMING ISSUES THAT PREVENTED CLAIMS FOR 'WELL-CHILD MEDICAL SCREENING' VISITS (CODES 99381-99385 AND 99391-99395) FROM CORRECTLY PROCESSING HAVE BEEN CORRECTED AND THE CLAIM PAYMENT ADJUSTED. 

2. CLAIMS FOR VISION AND HEARING SCREENINGS THAT INCORRECTLY DENIED WITH
ERROR 210 HAVE BEEN RECYCLED AND PROGRAMMING CORRECTED. CLAIMS FOR THESE SITUATIONS WERE PROCESSED ON THE RA OF 12-28-04.

ATTENTION PROVIDERS SUBMITTING ELECTRONIC CLAIMS

IT IS IMPERATIVE THAT ALL EMC PROPRIETARY ELECTRONIC CLAIMS SUBMISSIONS CONVERT TO HIPAA COMPLIANT FORMS 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: 

PROFESSIONAL AND KIDMED - MARCH 31, 2005 
OTHER PROGRAMS - TO BE DETERMINED 

PROPRIETARY CLAIMS SUBMITTED AFTER APPLICABLE DEADLINES WILL NOT BE PROCESSED. 

ATTENTION ALL PROVIDERS CURRENTLY TESTING 837 EDI TRANSACTIONS AND RECEIVING TEST 835S: THE TEST EDI BULLETIN BOARD WILL BE UNAVAILABLE FROM MIDNIGHT JANUARY 27TH, 2005 THROUGH 10:00 A.M., JANUARY 31, 2005 DUE TO ROUTINE MAINTENANCE. PLEASE SCHEDULE YOUR 837 TESTING AROUND THIS SCHEDULED DOWNTIME.