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 THE 1/01/02 VERSION OF APPENDIX C:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

ATTENTION PHARMACY AND PRESCRIBING PROVIDERS

YOU RECENTLY RECEIVED A MEMORANDUM DATED JANUARY 13, 2003 FROM DHH CONCERNING MONTHLY PRESCRIPTION LIMITS & CLINICAL DRUG INQUIRY APPLICATIONS. PAGE 2 OF THAT MEMO CONTAINED ERRORS ON DATES AT THE TOP OF THE PAGE & IN THE BODY OF PARAGRAPH 5. THESE DATES SHOULD READ JANUARY 13, 2003 & FEBRUARY 3, 2003 RESPECTIVELY. PLEASE MAKE CORRECTIONS TO YOUR MEMO, & WE APOLOGIZE FOR ANY CONFUSION THIS ERROR MAY HAVE CAUSED.   

ATTENTION WAIVER PROVIDERS

EFFECTIVE IMMEDIATELY, PLACE OF SERVICE CODE 6 IS NO LONGER ACCEPTABLE FOR PROCEDURE CODES Z0002 AND Z0011. TO PREVENT CLAIM DENIALS, PLEASE USE AN APPROPRIATE PLACE OF SERVICE CODE FOR THESE PROCEDURES. IF YOU HAVE QUESTIONS ABOUT THE APPROPRIATE POS CODES, PLEASE CONTACT UNISYS PROVIDER RELATIONS AT 1-800-473-2783. 

ATTENTION ALL PROVIDERS

THE PROVIDER ENROLLMENT UNIT HAS MOVED. THE NEW PHONE NUMBER IS:225-237-3370. THE MAILING ADDRESS REMAINS UNISYS- PROVIDER ENROLLMENT UNIT, P.O. BOX 80519, BATON ROUGE, LA 70898-0159. PLEASE MAKE NOTE OF THIS NEW CONTACT INFORMATION. 

ATTENTION ALL MENTAL HEALTH REHAB PROVIDERS

AS YOU ARE AWARE, THERE IS A 14 DAY TIME LIMIT AFTER THE END OF A PA CYCLE TO INPUT YOUR SERVICE LOGS ON UTOPIA. THERE ARE NO EXCEPTIONS TO THE RULE. YOUR AGENCY SHOULD HAVE A BACKUP PLAN TO COVER ANY PROBLEM THAT CAN ARISE. PROGRAM OPERATIONS WILL NOT OVERRIDE THIS POLICY FOR ANY REASON. 

ATTENTION ALL HOME HEALTH PROVIDERS

IN THE DECEMBER 2001 ISSUE OF THE LOUISIANA REGISTER, HEALTH STANDARDS PUBLISHED THEIR MINIMUM STANDARDS FOR HOME HEALTH AGENCIES. INCLUDED WAS A CHANGE REGARDING SUPERVISION OF AIDES. THIS CHANGE WAS INADVERTENTLY MISSED AND THE OLD STANDARD REGARDING "EVALUATION OF AIDES" WAS PRINTED ON PAGE 2 OF THE 2002 PROVIDER TRAINING MANUAL PUBLISHED FOR THE PROVIDER TRAINING SEMINARS. PLEASE MAKE NOTE OF THE FOLLOWING, WHICH IS PART OF THE MINIMUM STANDARDS AND SHOULD BE ADHERED TO: PERIODIC ON SITE SUPERVISION WITH THE HOME HEALTH AIDE PRESENT SHALL BE ESTABLISHED AS PART OF THE AGENCY'S POLICIES AND PROCEDURES. IF THE PATIENT IS RECEIVING A SKILLED SERVICE (NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, OR SPEECH-LANGUAGE PATHOLOGY), THE SUPERVISORY VISITS SHALL BE MADE TO THE PATIENT'S RESIDENCE AT LEAST ONCE EVERY TWO WEEKS (NOT TO EXCEED 20 DAYS) BY THE RN OR APPROPRIATE THERAPIST TO ASSESS RELATIONSHIPS AND DETERMINE WHETHER GOALS ARE BEING MET. IF THE PATIENT IS NOT RECEIVING SKILLED NURSING SERVICES, A RN MUST MAKE A SUPERVISORY VISIT TO THE PATIENT'S RESIDENCE AT LEAST ONCE EVERY 62 
DAYS. IN ORDER TO ENSURE THAT THE AIDE IS PROPERLY CARING FOR THE PATIENT, THE SUPERVISORY VISIT MUST OCCUR WHILE THE HOME HEALTH AIDE IS PROVIDING PATIENT CARE.

NOTICE TO OPTOMETRISTS

EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2003, CPT CODE 66984-55 WAS ADDED TO THE LIST OF CODES PAYABLE TO OPTOMETRISTS. NOTE: AN UNMODIFIED 66984 WILL BE DENIED WITH ERROR EDIT 210. 

NOTICE TO HOME HEALTH PROVIDERS

IN A RECENT LEGISLATIVE REVIEW OF HOME HEALTH AGENCY RECORDS, IT WAS DISCOVERED THAT NOT ALL AGENCIES WERE COMPLYING WITH A REQUIREMENT IN THE MINIMUM STANDARDS FOR HOME HEALTH AGENCIES. THESE STANDARDS WERE PROMULGATED AS A RULE IN THE DECEMBER 20, 2001 LOUISIANA REGISTER, VOLUME27, NUMBER 12. THE REQUIREMENT IS THAT THE PATIENT OR A RESPONSIBLE PERSON MUST SIGN THE PERMANENT RECORD OF VISIT THAT IS RETAINED BY THE AGENCY. THE RESPONSIBLE PERSON MAY BE A SPOUSE, RELATIVE, NEIGHBOR OR FRIEND, BUT MAY NOT BE AN EMPLOYEE OF THE HOME HEALTH AGENCY. THE PERSON WHO SIGNS THE FORM SHOULD ALSO DATE IT. 

NOTICE TO PROVIDERS

THE DEPARTMENT OF HEALTH AND HOSPITALS WILL BE DELAYING THE FEBRUARY 3, 2003 IMPLEMENTATION OF THE MONTHLY PRESCRIPTION LIMIT IN THE MEDICAID PHARMACY PROGRAM AS PUBLISHED IN THE JANUARY 20,2003 LOUISIANA REGISTER.  THE PRESCRIPTION LIMIT IS BEING AMENDED TO PROVIDE AN OVERRIDE PROVISION WE WILL NOTIFY YOU OF THE IMPLEMENTATION DATE IN THE NEAR FUTURE.