RA Messages for April 12, 2005
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
FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
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.
PROVIDERS OF STERILIZATION PROCEDURES
EFFECTIVE JANUARY 1, 2005, ALL HARDCOPY CLAIMS SUBMITTED FOR STERILIZATION CPT CODE 58565 WITH CORRECT CONSENTS WILL BE PAYABLE. WHEN
THIS PROCEDURE IS RENDERED IN THE OFFICE SETTING, THE PRICE OF THE DEVICE IS COVERED IN THE PHYSICIAN'S PAYMENT. WHEN THE PROCEDURE IS
RENDERED IN AN OUTPATIENT SETTING, THE DEVICE COST IS PAYABLE TO THE FACILITY ONLY.
ATTENTION EPSDT HEALTH SERVICES PROVIDERS
EPSDT HEALTH SERVICES CLAIMS FOR DATES OF SERVICE 10-1-03 THROUGH 8-31-04 THAT HAD UNITS OF SERVICE INCORRECTLY CUTBACK HAVE BEEN
RECYCLED. THE CORRECTION IS REFLECTED ON THE RA OF 4-5-05.
CLAIMS FROM THE 3/22/05 RA THAT WERE DENIED ERRONEOUSLY WITH ERROR 164 (CLAIMS EXCEED AUTHORIZED DAYS), ARE BEING RECYCLED FOR CORRECT PAYMENT.
THESE CLAIMS ARE REFLECTED IN THE RA DATED 4/5/05 AND/OR 4/12/05.