RA Messages for February 14, 2005

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ATTENTION KIDMED AND PREVENTIVE MEDICINE PROVIDERS

A DHH EMERGENCY RULE REQUIRES ALL MEDICAID PROVIDERS SUBMITTING KIDMED/PREVENTIVE MEDICINE CLAIMS TO SUBMIT DETAIL CLAIM DATA INCLUDING THE ACTUAL SCREENING AND IMMUNIZATION SERVICES AND THE IMMUNIZATION STATUS; SUSPECTED CONDITIONS; AND REFERRAL INFORMATION RELATED TO SUSPECTED CONDITIONS.  THIS REQUIREMENT APPLIES TO BOTH ELECTRONIC AND PAPER CLAIMS.  ELECTRONIC 837P KIDMED TRANSACTIONS MUST INCLUDE THE K3 SEGMENT, AND THE "FILE EXTENSION" MUST BE KID, NOT PHY.  PROVIDERS BILLING PAPER CLAIMS MUST USE THE CMS 1500 CLAIM FORM WITH ONLY THE SCREENING CODES MUST NOW SUBMIT THE KM-3 CLAIM FORM WITH ALL DETAIL INFORMATION.  EDUCATIONAL EDITS (517 AND 518 OR HIPAA ADJUSTMENT REASON CODE 16 FOR 835 ELECTRONIC RA) CURRENTLY APPEAR ON ANY ELECTRONIC AND HARD COPY CLAIMS PAYMENTS IF ALL APPLICABLE KIDMED CLAIM DETAIL IS NOT PROVIDED.  EFFECTIVE APRIL 1, 2005, EDITS 517 (KIDMED FORMAT REQUIRED - CLAIM MUST BE SUBMITTED IN KIDMED FORMAT), 518 (KIDMED INFORMATION MISSING - IMMUNIZATION AND SUSPECTED CONDITION INFORMATION REQUIRED) AND HIPAA REASON CODE 16 WILL DENY CLAIMS THAT ARE SUBMITTED ON THE 837P OR THE CMS 1500 CLAIM FORM WITHOUT KIDMED DETAIL.

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ATTENTION PROFESSIONAL SERVICES PROVIDERS

EFFECTIVE FEBRUARY 8, 2005, THE 2005 HCPCS CODES WERE LOADED TO OUR FILES AND MAY BE BILLED FOR DATES OF SERVICE JANUARY 1, 2005 FORWARD. LOOK FOR THE 2005 FEE SCHEDULE ON THE LOUISIANA MEDICAID WEBSITE AT AT LAMEDICAID.COM IN THE NEAR FUTURE. 

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2004, THE FOLLOWING CPT CODES WERE ADDED TO THE LIST OF CODES PAYABLE TO CLINICAL NURSE SPECIALIST, CERTIFIED NURSE PRACTITIONER AND NURSE MIDWIFE. 

10061	10080	10081	10121	10140	10180	28190	36415	46600	82670
83001	84443	84460	84702	85651	86308	87177	93230	J2175

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ATTENTION COMMUNITYCARE AND KIDMED PROVIDERS

YOU WERE PREVIOUSLY NOTIFIED THAT CP-0-92 AND RS-0-07 REPORTS ARE NOW LOADED MONTHLY ON THE LA MEDICAID WEB SITE. THESE REPORTS REMAIN ON THE SITE FOR 2 MONTHS TO ALLOW PROVIDERS TO ACCESS THE CURRENT AND THE PREVIOUS MONTHS' REPORTS. EFFECTIVE MARCH 1, 2005, REQUESTS FOR REPORTS OR SIGNATURE PAGES TO BE REPRINTED HARDCOPY WILL NOT BE HONORED. PLEASE ENSURE THAT YOU HAVE PROCEDURES IN PLACE TO RETRIEVE THESE REPORTS AS NEEDED. 

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

BEGINNING DECEMBER 21, 2004, EFFECTIVE WITH DATES OF SERVICE JANUARY 1, 2004 LOUISIANA MEDICAID WILL ACCEPT CLAIMS WITH MODIFIER 63 TO INDICATE PROCEDURES PERFORMED ON NEONATES AND INFANTS UP TO A PRESENT BODYWEIGHT
OF 4 KG 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. PROVIDERS SHOULD RESUBMIT PREVIOUSLY DENIED CLAIMS. 

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ATTENTION DENTAL PROVIDERS BILLING REMINDER

THE DATE OF SERVICE ON A CLAIM FOR PAYMENT MUST REFLECT THE DATE THAT THE SERVICE WAS COMPLETED/DELIVERED (REFER TO THE 2003 DENTAL SERVICES MANUAL, PAGE 16-11). THE DENTAL SURVEILLANCE AND UTILIZATION DEPARTMENT CONTINUES TO IDENTIFY DENTAL PROVIDERS WHO HAVE BILLED AND HAVE BEEN PAID FOR ROOT CANAL THERAPY PRIOR TO THE COMPLETION OF SERVICE. NO CLAIM FOR PAYMENT FOR ANY DENTAL SERVICE MAY BE FILED PRIOR TO THE COMPLETION/DELIVERY OF THE SERVICE. THIS INCLUDES, BUT IS NOT LIMITED TO, ROOT CANAL THERAPY, A COMPLETE OR PARTIAL DENTURE AND SPACE MAINTAINERS. AT A MINIMUM, MEDICAID WILL RECOVER THE PAYMENT FOR ALL CLAIMS BILLED WHEN THE DATE OF SERVICE ON THE CLAIM DOES NOT REFLECT THE DATE THE SERVICE WAS COMPLETED. 

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ATTENTION ALL PROVIDERS

EFFECTIVE APRIL 1, 2005, ALL HARDCOPY AND PROPRIETARY ELECTRONIC MEDIA CLAIMS THAT ARE ELIGIBLE FOR 837 HIPAA-COMPLIANT TRANSACTIONS SUBMISSION WILL BE HELD AT LEAST 21 DAYS PRIOR TO FINAL ADJUDICATION. ALL CLAIMS RECEIVED FOR LONG-TERM CARE, CASE MANAGEMENT AND NON- EMERGENCY TRANSPORTATION SERVICES AND CLAIMS REQUIRING ATTACHMENTS WILL NOT BE DELAYED BY THIS PROCESS. IT IS IMPERATIVE THAT YOU BEGIN SUBMITTING ELECTRONIC CLAIMS IN APPROVED 837 TRANSACTIONS PRIOR TO THIS IMPLEMENTATION TO ENSURE THAT PAYMENTS WILL NOT BE DELAYED. FOR ANY QUESTIONS, PLEASE CALL PROVIDER RELATIONS AT 800-473-2783 OR (225) 924-5040. 

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ATTENTION EDI SUBMITTERS

FOR EACH 837 TRANSACTION FILE SUBMITTED TO LOUISIANA MEDICAID, TWO ACKNOWLEDGEMENTS ARE PRODUCED AND SHOULD BE DOWNLOADED TO VERIFY THE
SUBMISSION - NAMELY: TA1 AND 997. THE TA1 VERIFIES THAT THE FILE HAD RECEIVED A CORRECT HEADER/TRAILER. THE TA1 SHOULD BE REVIEWED TO SEE IF IT CONTAINS AN "A" (ACCEPTED) OR "R" (REJECTED). THE 997 IS USED TO REPORT WHETHER OR NOT THE FILE CONTAINS SYNTAX ERRORS. THE 997 CONTAINS TWO TRANSACTION SETS: AK5 AND AK9 WHICH WILL INDICATE "A" (ACCEPTED) OR "R" (REJECTED). PLEASE REFER TO THE EDI GENERAL COMPANION GUIDE FOR MORE DETAILED INFORMATION ABOUT THESE ACKNOWLEDGEMENTS. THE COMPANION GUIDE CAN BE DOWNLOADED AT 
WWW.LAMEDICAID.COM/PROVWEB1/HIPAABILLING/HIPAAINDEX.HTM.