RA Messages for February 1, 2005

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ATTENTION PHARMACY PROVIDERS

RECENTLY STATES WERE NOTIFIED BY THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) TO MAKE CERTAIN DRUG PRODUCTS NON-PAYABLE BECAUSE THEY WERE NOT PROPERLY LISTED WITH THE FOOD AND DRUG ADMINISTRATION EFFECTIVE JANUARY 1, 2005. LA MEDICAID WILL REINSTATE THESE PRODUCTS AS PAYABLE IF NOTIFIED BY CMS TO DO SO.

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ATTENTION PROFESSIONAL SERVICES PROVIDERS

THE MESSAGE THAT RAN ON THE RAS DATED 09/23/03, 09/30/03, AND 10/07/03, 
CONCERNING A FEE INCREASE FOR PROCEDURE CODES RELATED TO MUSCULOSKELETAL SYSTEM SERVICES, CONTAINED AN INCORRECT CODE RANGE. THE CORRECT CODE RANGE FOR THIS FEE IS 20000-29999. PLEASE MAKE THIS NECESSARY CORRECTION TO YOUR INTERNAL DOCUMENTATION. 

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ATTENTION ALL PROVIDERS

EFFECTIVE APRIL 1, 2005, ALL HARDCOPY AND PROPRIETARY ELECTRONIC MEDIA CLAIMS 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 HOSPITAL PROVIDERS

THIS WILL SERVE AS A CLARIFICATION OF THE POLICY CONCERNING BILLING OUTPATIENT SERVICES PROVIDED LESS THAN 24 HOURS PRIOR TO AN INPATIENT ADMISSION. OUTPATIENT SERVICES PROVIDED WITHIN 24 HOURS OF AN INPATIENT ADMISSION MUST BE ROLLED INTO THE INPATIENT STAY AND BILLED AS PART OF THE INPATIENT CLAIM. THE ADMISSION DATE ON THE CLAIM SHOULD BEGIN WITH THE ACTUAL DATE OF THE INPATIENT ADMISSION. THE EXCEPTION TO THIS RULE IS WHEN A PATIENT RECEIVES OUTPATIENT SERVICE AND DOES NOT DISCHARGE HOME PRIOR TO BEING ADMITTED AS AN INPATIENT. IN THESE CASES, THE ADMISSION DATE SHOULD BE THE DATE THE OUTPATIENT SERVICES WERE PROVIDED. ADDITIONALLY, PSYCHIATRIC PATIENTS ADMITTED THROUGH THE EMERGENCY ROOM SHOULD HAVE THE ER CHARGES ROLLED INTO THE INPATIENT PSYCHIATRIC BILL (EVEN WHEN THE FACILITY HAS SEPARATE PROVIDER NUMBERS FOR ACUTE AND PSCH SERVICES), AND THE ADMISSION DATE OF THE INPATIENT PSYCHIATRIC CLAIM SHOULD BE THE DATE THE PATIENT IS ADMITTED TO THE PSYCHIATRIC UNIT.