RA Messages for March 30, 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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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.

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ATTENTION ALL PROVIDERS

THE BACK OF THE RECIPIENT'S MEDICAID PLASTIC ID CARD CONTAINS A PHONE NUMBER FOR THE RECIPIENT TO CONTACT FOR QUESTIONS ABOUT THE MEDICAID CARE OR THE MEDICAID PROGRAM. THE CORRECT TELEPHONE NUMBER FOR THESE CALLS IS 1-800-834-3333.  WHEN ASSISTING YOUR MEDICAID PATIENTS, PLEASE ENSURE THAT YOU PROVIDE THEM WITH THIS NUMBER, AND DISCARD ANY AND ALL OTHER TELEPHONE NUMBERS YOU MAY HAVE FOR THIS PURPOSE.

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ATTENTION DME PROVIDERS

PAYMENT FOR BOTH OPEN AND CLOSED SYSTEM CATHETERS HAVE BEEN AUTHORIZED/BILLED USING PROCEDURE CODE A4624 AND ALL FACIAL PROSTHETICS HAVE BEEN AUTHORIZED/BILLED USING PROCEDURE CODE L8499.  EFFECTIVE IMMEDIATELY, THE FOLLOWING HIPAA COMPLIANT PROCEDURE CODES SHOULD BE USED: A4609 - TRACHEAL SUCTION CATHETER/LESS THAN 72 HOURS IN USE IN A CLOSED SYSTEM @ $10.01/CATHETER. A6410 - TRACHEAL SUCTION CATHETER/72 HOURS OR MORE OF USE @ $15.64/CATHETER. A4624 - TRACHEAL SUCTION CATHETER/ANY TYPE OTHER THAN A CLOSED SYSTEM @ $1.76/CATHETER. L8040 - NASAL PROSTHESIS @1,352.99/INITIAL FITTING, $1,285.34/REPLACEMENT WITH NEW IMPRESSION/MOULAGE OR $541.18 REPLACEMENT USING PRIOR MASTER MODEL. L8041 - MIDFACIAL PROSTHESIS @1,630.81/INITIAL FITTING, $1,549.26/REPLACEMENT WITH NEW IMPRESSION/MOULAGE OR $541.18 REPLACEMENT USING A PRIOR MASTER MODEL. L8042 - ORBITAL PROSTHESIS @1,832.37/INITIAL FITTING, $1,740.75/REPLACEMENT WITH NEW IMPRESSION/MOULAGE OR $732.95/REPLACEMENT USING A PRIOR MASTER MODEL.