RA Messages for March 16, 2004

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ATTENTION PHARMACIES

ERROR (EOB) CODE #459 WAS RECENTLY CHANGED FROM A 'CLAIM PENDING' STATUS TO A 'DENY' STATUS.  ERROR CODE 459 HAS A SHORT DESCRIPTION OF 'DENY FOR FILE REVIEW' AND A LONG DESCRIPTION OF 'DENY FOR REVIEW/CALL POS HELP DESK'. CLAIMS FOR NEW DRUGS THAT HAVE NOT BEEN REVIEWED BY THE DEPARTMENT OF HEALTH AND HOSPITALS (DHH) WILL NOW DENY FOR REIMBURSEMENT WITH ERROR CODE 459.  ERROR CODE 459 IS LINKED TO NCPDP CODE 70 - PRODUCT/SERVICE NOT COVERED. WHEN A CLAIM DENIES WITH ERROR 459, THE PROVIDER SHOULD CONTACT THE POS HELP DESK AT 800-648-0790 TO REQUEST A REVIEW OF THE DRUG.

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ATTENTION FREE STANDING REHABILITATION CENTERS

A CORRECTION HAS BEEN MADE TO THE 2004 REHABILITATION CENTERS PROVIDER 
TRAINING PACKET. THE PACKET SHOULD HAVE REFLECTED THAT LOCAL PROCEDURE 
CODES Y7702 (PT EVALUATION), Y7812 (OT EVALUATION), AND Y7902 (WHEELCHAIR SEATIN EVALUATION) WERE CONVERTED TO THE NEW HIPAA STANDARD CODES DESIGNATED IN THE CROSSWALK ON PAGE 11 EFFECTIVE WITH DATE OF SERVICE 10/01/03 AND AFTER. ALSO, PAGE 13 OF THE PACKET SHOULD REFLECT AN EFFECTIVE DATE OF 10/01/03 IN THE BILLING INSTRUCTIONS FOR WHEELCHAIR SEATING EVALUATIONS. WE REQUEST THAT PROVIDERS MAKE THE NECESSARY CHANGES TO THEIR TRAINING PACKETS. 

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ATTENTION IMMUNIZATION PROVIDERS

WITH HIPAA IMPLEMENTATION IT BECAME NECESSARY FOR PROVIDERS ADMINISTERING IMMUNIZATIONS TO USE ADMINISTRATION CODE 90471 ACCOMPANIED BY THE APPROPRIATE VACCINE CPT CODE FOR A SINGLE INJECTION AND ADMINISTRATION CODE 90472 ACCOMPANIED BY THE APPROPRIATE VACCINE CPT CODE(S) FOR EACH ADDITIONAL INJECTION. EFFECTIVE IMMEDIATELY, WHEN THE BILLING OF THESE CODES EXCEEDS THE SIX LINE LIMIT OF THE CMS-1500 CLAIM FORM, CODE 90471 WITH THE ACCOMPANYING VACCINE DETAIL LINE SHOULD BE BILLED ON ONE CLAIM FORM, AND CODE 90472 WITH THE ACCOMPANYING VACCINE DETAIL LINES SHOULD BE BILLED ON ANOTHER CLAIM FORM. CLAIMS WILL BE RECYCLED WITHIN THE NEXT FEW WEEKS. IF YOU HAVE QUESTIONS CONCERNING THIS CHANGE, CONTACT PROVIDER RELATIONS AT (800) 473-2783 OR (225) 924-5040. 

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES 

EFFECTIVE WITH THE DATE OF SERVICE JULY 1, 2003 CPT CODE G0202 FOR MAMMOGRAPHY WAS MADE PAYABLE ON THE PROFESSIONAL COMPONENT FILE AT 
A FEE OF $48.69. THIS CODE IS RESTRICTED TO CROSS-OVER CLAIMS. 

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PCP'S AND HOSPITALS PLEASE NOTE THAT ON 3/17/04 THE ELECTRONIC REFERRAL AUTHORIZATION (E-RA) APPLICATION WILL BE UPDATED AND WITH ENHANCED SEARCH CAPABILITIES. 

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES 

THE POLICY LIMITING THE NUMBER OF ULTRASOUNDS DURING PREGNANCY WAS CHANGED EFFECTIVE WITH DATE OF SERVICE 10-01-2003. CLAIMS THAT DENIED IN ERROR WERE RECYCLED AND APPEARED ON THE RA OF 02-17-2004. 

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ATTENTION EPSDT HEALTH SERVICES PROVIDERS 

DURING THE MOST RECENT PHASE OF HIPAA IMPLEMENTATION EPSDT HEALTH SERVICES CLAIMS FOR CODES 97110 AND 97530 WERE ERRONEOUSLY DENIED WITH EDIT 191 (PROCEDURE REQUIRES PRIOR AUTHORIZATION). THESE CLAIM DENIALS HAVE BEEN RECYCLED AND PROCESSED ON THE MARCH 23, 2004 RA. QUESTIONS SHOULD BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 800-473-2783 OR 225-924-5040.