RA Messages for April 15, 2003

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ATTENTION HOME AND COMMUNITY BASED WAIVER SERVICES

FOR INFORMATION ABOUT HOME AND COMMUNITY BASED WAIVER SERVICES AS AN ALTERNATIVE LONG TERM CARE OPTION, PLEASE CALL 1-800-660-0488.

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

NOTICE TO PHYSICIANS, ANESTHESIOLOGISTS, AND HOSPITALS

SUBMISSION FOR CHARGES RELATED TO STERILIZATION PERFORMED WHEN THE CONSENT WAS NOT OBTAINED THIRTY DAYS PRIOR TO THE STERILIZATION MUST INCLUDE DOCUMENTATION TO CONFIRM THE EXPECTED DATE OF DELIVERY IN ADDITION TO THE CONSENT FORM WITH THE ESTIMATED DATE OF DELIVERY OR ESTIMATED DATE OF CONFINEMENT INDICATED IN THE PROPER AREA.

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NOTICE TO ALL PROVIDERS

PRESCRIPTIONS FOR ENTERAL FORMULA OR OTHER PRIOR AUTHORIZED SERVICES REQUIRE A REFERRAL IF THE PATIENT IS LINKED TO A PCP IN THE COMMUNITYCARE PROGRAM. PROVIDERS COORDINATING CARE FOR PATIENTS WITH SERIOUS MEDICAL CONDITIONS SUCH AS CANCER, END STAGE RENAL DISEASE, OR HIV SHOULD THUS OBTAIN THE COMMUNITYCARE REFERRAL, WHICH MAY BE PASSED ON TO OTHER PROVIDERS TREATING THE PATIENT FOR THIS CONDITION. REFERRALS FOR SERIOUS AND CHRONIC MEDICAL CONDITIONS MAY BE GIVEN FOR A PERIOD OF TIME OF ONE YEAR. QUESTIONS REGARDING THIS MATTER MAY BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 1-800-473-2783.

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IMPORTANT MESSAGE TO ALL COMMUNITYCARE PROVIDERS

SOME CONCERNS HAVE BEEN EXPRESSED BY PROVIDERS THAT COMMUNITYCARE PCPS ARE NOT GRANTING REFERRALS IN A TIMELY MANNER. ALL COMMUNITYCARE PCPS SHOULD REVIEW CAREFULLY ANY REQUEST FOR A REFERRAL AND RESPOND TIMELY. IF THE COMMUNITYCARE PCP FEELS THAT THE ORIGINAL REQUEST DOES NOT CONTAIN ADEQUATE INFORMATION, HE/SHE MAY REQUEST ADDITIONAL INFORMATION BEFORE MAKING A FINAL DECISION TO GRANT OR TO DENY THE REFERRAL. A RESPONSE TO ALL REQUESTS FOR REFERRALS SHOULD BE GIVEN WITHIN TEN DAYS OF RECEIPT OF THE REQUEST, AS SPECIFIED IN SECTION 9.1.2 OF THE COMMUNITYCARE HANDBOOK. QUESTIONS ABOUT THESE REFERRALS MAY BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 1-800-473-2783.

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TAD BILLERS

IF YOU CURRENTLY BILL MEDICAID WITH A TAD, PLEASE NOTE THAT THE COMPANION GUIDES AND BILLING INSTRUCTIONS ARE BEING DEVELOPED TO ALLOW YOU TO BILL USING THE X12N 837 INSTITUTIONAL EDI TRANSACTION OR THE UB92 PAPER FORM. WE ANTICIPATE MAKING THESE AVAILABLE TO YOU OR YOUR SOFTWARE VENDOR, BILLING AGENT, OR CLEARINGHOUSE ON THE WWW.LAMEDICAID.COM WEBSITE IN MID-MAY. THE LINK WILL BE BILLING INSTRUCTIONS AND COMPANION GUIDES. PLEASE CONTINUE TO CHECK YOUR RA MESSAGES AND THE WWW.LAMEDICAID.COM WEBSITE FOR UPDATES. 

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ATTENTION ALL DENTAL PROVIDERS

EFFECTIVE MAY1,2003,THE FOLLOWING CHANGES WILL BE MADE IN THE DENTAL PROGRAM:1THE 2002 ADA CLAIM FORM IS REQUIRED, REGARDLESS OF DATE OF SERVICE; 2 THE 2002 ADA CLAIM FORM IS REQUIRED FOR PRIOR AUTHORIZATION REQUESTS; 3 THE NEWLY REVISED EPSDT 209 AND ADULT 210 ADJUSTMENT/VOID FORMS ARE REQUIRED, REGARDLESS OF DATE OF SERVICE;4 ALL DENTAL PROCEDURE CODES USED ON THE ADA FORM WILL BE CHANGED FROM A O TO A D IN THE LEADING POSITION (FOR DATES OF SERVICE PRIOR TO 5/1/03,CLAIMS MUST CONTAIN THE OLD PROCEDURE CODES WITH A D IN THE LEADING POSITION; CLAIMS FOR DATES OF SERVICE 5/1/03 AND AFTER MUST USE THE NEW HIPAA STANDARD CODES AS LISTED IN THE 
2003 MEDICAID DENTAL FEE SCHEDULE);5 TWO NEW ERROR CODES WILL BE ADDED FOR DENTAL CLAIM DENIALS. CODE 598;PA TOOTH/ORAL CAVITY CODE NOT SAME AS CLAIM-THE TOOTH NUMBER OR LETTER IN THE CLAIM DOES NOT MATCH THE TOOTH # OR ORAL CAVITY DESIGNATOR PRIOR AUTHORIZED. CODE 677:RESTORATIVE/SURGICAL PROCEDURE REQUIRED-NITROUS OXIDE(D9230)OR BEHAVIOR MANAGEMENT(D9920)IS ONLY REIMBURSABLE FOR DATES OF SERVICE ON WHICH RESTORATIVE AND/OR SURGICAL SERVICES (CODES D2140-D4999 AND D7140-D7999)ARE PERFORMED. IF ONE OF THE ALLOWABLE RESTORATIVE/ SURGICAL PROCEDURES IS NOT BILLED FOR THE SAME DATE OF SERVICE, THE CLAIM FOR NITROUS OXIDE OR BEHAVIOR MANAGEMENT WILL DENY WITH THIS CODE. WITH THE EXCEPTION OF ERROR CODE 677,THE INFORMATION ABOVE WAS DISCUSSED IN DETAIL AT THE 2003 DENTAL PROVIDER TRAINING HELD 3/31-4/4/03.SINCE PROVIDERS ARE RESPONSIBLE FOR THE INFORMATION CONTAINED IN THE TRAINING PACKETS, PROVIDERS WHO WERE UNABLE TO SHOULD REQUEST A COPY OF THE TRAINING PACKET BY CALLING PROVIDER RELATIONS AT 800-473-2783 OR (225)924-5040.THIS PACKET WILL ALSO BE AVAILABLE ON THE LA MEDICAID WEB SITE, WWW.LAMEDICAID.COM , WITHIN THE COMING WEEKS.