RA Messages for January 4, 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
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.
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.
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.