RA Messages for March 14, 2005

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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	46600	82670
83001	84443	84460	84702	85651	86308	87177	93230	J2175

PROCEDURE CODE 36415 WAS LISTED IN ERROR ON THE 2-14-05 RA AS ONE OF THE CODES PAYABLE TO CNS, CNP AND NURSE MIDWIFE.  THIS CODE IS RESTRICTED TO NURSING HOMES, HOSPITAL LABS AND INDEPENDENT LABS.  WE APOLOGIZE FOR THE ERROR. 

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ATTENTION ALL PROVIDERS

DUE TO A CLAIMS PROCESSING ERROR, THE THIRD PARTY LIABILITY (TPL) PAYMENTS REPORTED ON SOME MEDICAID CLAIMS SUBMITTED AFTER 1-1-2005 WERE NOT SUBTRACTED FROM THE MEDICAID PAYMENT AMOUNT FOR IMPACTED CLAIMS. WE WILL REPROCESS THESE CLAIMS (NOTED WITH THE NUMBER 5043 IN THE FIRST FOUR DIGITS OF THE ICN) ON THE MARCH 8 RA AND DEDUCT THE APPROPRIATE TPL AMOUNT. AS A RESULT, A NEGATIVE BALANCE COULD RESULT FOR AFFECTED PROVIDERS WHICH WILL IMPACT THE TOTAL PAYMENT AMOUNT YOU WILL RECEIVE ON THAT AND POSSIBLE FUTURE REMITTANCE ADVICES. CONTACT UNISYS PROVIDER RELATIONS DEPARTMENT AT (800) 473-2783 OR (225) 924-5040 IF YOU HAVE ANY QUESTIONS ABOUT THIS ACTION. 

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OUR RAS NOW DISPLAY BOTH MEDICAL RECORD/PATIENT ACCOUNT # & PATIENT CONTROL # APPEARING ON CLAIMS. MEDICAL RECORD/PATIENT ACCOUNT # WILL APPEAR BELOW THE RECIPIENT ID & PATIENT CONTROL # WILL APPEAR BELOW DATE OF SERVICE ON THE RA. INFORMATION SUBMITTED IN EITHER OR BOTH OF THESE FIELDS ON YOUR CLAIM WILL APPEAR ON THE RA FOR THAT RECIPIENT.

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ATTENTION ANESTHESIA PROVIDERS

EFFECTIVE 3/1/05. THE HARD COPY MANDATE FOR THE FOLLOWING ANESTHESIA CODES HAS BEEN LIFTED FOR DATES OF SERVICE 10/01/03 AND FORWARD. 

00300	00402	00404	00406	00410	00620	00630	00790	00792	00794
00800	00810	00820	00840	00872	00873	00918	00920	00940	00942

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ATTENTION ALL MENTAL HEALTH REHAB PROVIDERS

PLEASE NOTE THE FOLLOWING AS PUBLISHED IN THE CURRENT MENTAL HEALTH REHAB MANUAL, SECTION 5-1-B-1, DATED JULY 1, 1999 REGARDING APPROVAL OF ASSESSMENT, WHICH STATES: 

"THE ASSESSMENT MUST BE COMPLETED WITHIN 30 DAYS OF APPROVAL. EXTENSIONS
MUST BE APPROVED BY THE PA UNIT." 

IF THERE ARE EXTENUATING CIRCUMSTANCES, THE MHR PROVIDER SHOULD THOROUGHLY DOCUMENT THE REASON FOR THE REQUEST FOR EXTENSION. THE PA STAFF WILL THEN DETERMINE IF THE EXTENSION IS WARRANTED ON A CASE BY CASE BASIS. 

IF YOU HAVE ANY FURTHER QUESTIONS, CONTACT DAWN R. MATTE, PROGRAM 
COORDINATOR, AT 225-342-1247.

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ATTENTION SUBMITTERS OF ELECTRONIC CLAIMS

BEGINNING 1-1-2005, ALL CLAIMS SUBMITTED TO LOUISIANA MEDICAID VIA ELECTRONIC SUBMISSION WILL REQUIRE ONE ANNUAL CERTIFICATION FORM PER SUBMITTER NUMBER. THIS CERTIFICATION FORM WILL BE RENEWED DURING THE 4Q OF EACH YEAR FOLLOWING THE INITIAL TRANSITION. CORRESPONDENCE WILL BE MAILED TO EACH OPEN SUBMITTER OF FILE IN EARLY APRIL. THE FIRST DEADLINE FOR RECEIPT OF COMPLETED ANNUAL CERTIFICATION FORMS IS MAY 15, 2005. 

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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 PSYCH SERVICES), AND THE ADMISSION DATE OF THE INPATIENT PSYCHIATRIC CLAIM SHOULD BE THE DATE THE PATIENT IS ADMITTED TO THE PSYCHIATRIC UNIT.