RA Messages for March 7, 2000 Print

RA Messages for March 7, 2000

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 8/15/98 VERSION OF APPENDIX A:

PLEASE MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX C:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

RURAL HEALTH CLINICS

RURAL HEALTH CLINICS HAVE NEW LICENSING REQUIREMENTS AS OF OCTOBER 20, 1999. THESE REQUIREMENTS MAY SUPERCEDE PREVIOUS POLICY. RHC'S SHOULD TAKE STEPS TO ENSURE THE NEW STANDARDS AS FOLLOWED. 

ATTENTION HOME HEALTH PROVIDERS

YOU RECENTLY RECEIVED A LETTER CONCERNING BILLING AND PAYMENT CHANGES IN THE HOME HEALTH PROGRAM. AMONG THE CHANGES IS A REQUIREMENT THAT WHEN 
REQUESTING PRIOR AUTHORIZATION FOR EXTENDED NURSING CARE, THE FIRST HOUR
OF CARE MUST NOW BE INCLUDED WITH THE PRIOR AUTHORIZATION REQUEST. FOR 
EXTENDED NURSING CARE PAS ONLY, THIS MEANS THAT YOU MUST FILE A RECONSI DERATION FOR ANY PAS PREVIOUSLY APPROVED THAT CONTAIN DATES OF SERVICE FEBRUARY 1, 2000 AND AFTER IN ORDER TO RECEIVE APPROVAL FOR THE TOTAL 
NUMBER OF HOURS TO BE PROVIDED WITHIN THE SPAN DATES OF THE PA. YOU SHOULD SUBMIT A COPY OF THE PREVIOUSLY APPROVED PA LETTER AND A CORRECTED PA-07 SHOWING THE TOTAL NUMBER OF HOURS TO BE PROVIDED WITHIN THE SPAN DATES ON THE PA (EVEN IF SOME OF THESE HOURS HAVE ALREADY BEEN PROVIDED). PLEASE INDICATE ON THE CORRECTED PA-07 EXACTLY HOW MANY HOURS PER DAY AND HOW MANY DAYS PER WEEK ARE BEING REQUESTED. THE HOURS NEEDED TO ACCOMMODATE THE NEW BILLING PROCEDURE WILL BE CALCULATED UNDER THE SAME PA NUMBER. YOU WILL RECEIVE A NEW PA APPROVAL LETTER FOR THAT PA NUMBER.

NOTICE TO KIDMED PROVIDERS

THERE IS A TYPOGRAPHICAL ERROR IN THE KIDMED MANUAL ON PAGE VIII-7. UNDER EPSDT CONSULTATION CODE X0180 IT SAYS THAT A NURSE ASSISTANT CAN PERFORM THIS PROCEDURE. THIS IS INCORRECT. THAT SHOULD READ PHYSICIAN ASSISTANT, NURSE ASSISTANTS CANNOT PERFORM KIDMED NURSE CONSULTATIONS. PLEASE MAKE NOTE OF THIS IN YOUR KIDMED MANUALS. 

HOSPITALS

SPLIT-BILLING REQUIREMENTS DUE TO EMERGENCY RULES REDUCING PER DIEMS EFFECTIVE MARCH 1, 2000 AND MARCH 8, 2000. ALL LONG TERM CARE HOSPITALS AND ALL PRIVATE AND PUBLIC PSYCHIATRIC HOSPITALS, INCLUDING PSYCHIATRIC UNITS WITHIN PRIVATE ACUTE CARE  HOSPITALS, WILL BE REQUIRED TO SPLIT-BILL MEDICAID INPATIENT CLAIMS BASED ON DATE OF SERVICE EFFECTIVE MARCH 1, 2000 (ONE-TIME ONLY). ALSO, ALL ACUTE CARE HOSPITALS (EXCEPT CHARITY HOSPITALS) WILL BE REQUIRED TO SPLIT-BILL MEDICAID INPATIENT CLAIMS BASED ON DATE OF SERVICE EFFECTIVE MARCH 8, 2000 (ONE-TIME ONLY).