RA Messages for April 16, 2007

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ATTENTION PROVIDERS

THE FORM CMS-1500 (08-05) WILL BE ACCEPTED BY LOUISIANA MEDICAID FOR ALL DATES OF SUBMISSION BEGINNING MARCH 5, 2007, BUT WILL NOT BE MANDATED FOR USE UNTIL JUNE 4, 2007.

PROVIDERS WILL BE PERMITTED TO USE EITHER THE CURRENT FORM CMS-1500 (12-90) OR THE REVISED FORM CMS-1500(08-05) BEGINNING MARCH 5, 2007 THROUGH JUNE 3, 2007.

EFFECTIVE JUNE 4, 2007, THE FORM CMS-1500 (12-90) WILL BE DISCONTINUED AND ONLY THE FORM CMS-1500 (08-05) SHALL BE USED. THIS INCLUDES ALL REBILLING OF CLAIMS EVEN THOUGH EARLIER SUBMISSIONS MAY HAVE BEEN ON THE FORM CMS-1500 (12-90).

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ATTENTION PROVIDERS

EFFECTIVE 7-2-2007, IN ACCORDANCE WITH A RECENT DHH DIRECTIVE, UNISYS WILL NO LONGER ACCEPT COPIES OF STANDARD CLAIM FORMS, THE REGULATIONS DO NOT ALLOW THE COPYING OF HARDCOPY CLAIM FORMS. THESE INCLUDE THE UB-92, UB-04, CMS 1500 (12-90), CMS 1500 (08-05), ADA, AND THE NCPDP UNIVERSAL CLAIM FORM. ANY HARD COPY CLAIMS SUBMITTED TO UNISYS FOR PROCESSING MUST BE AN ORIGINAL, STANDARD CLAIM FORM AND MUST MEET THE LICENSURE/ COPYRIGHT REQUIREMENTS OF THE PARTICULAR ORGANIZATION THAT REGULATES THAT CLAIM FORM. THIS INCLUDES ORIGINAL SUBMISSIONS, RE-SUBMISSIONS OF PREVIOUS CLAIMS, AND CLAIM ADJUSTMENTS/VOIDS.

WITH THE IMPLEMENTATION OF THIS REQUIREMENT, PROVIDERS THAT ARE ROUTINELY BILLING ALL CLAIMS HARD COPY MAY WANT TO CONSIDER TRANSITIONING TO ELECTRONIC CLAIMS SUBMISSION. QUESTIONS CONCERNING EDI BILLING MAY BE DIRECTED TO THE UNISYS EDI DEPARTMENT AT 225/216-6000, OPTION 2. A COMPLETE LISTING OF APPROVED EDI VENDORS IS AVAILABLE ON THE LA MEDICAID WEB SITE, WWW.LAMEDICAID.COM, LINK HIPAA INFORMATION CENTER/LINK VBC LIST. PLEASE CONTACT THE VENDORS FOR SPECIFIC INFORMATION ON THEIR SERVICES AS A WIDE RANGE OF PACKAGES/FEES ARE AVAILABLE.

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ATTENTION COMMUNITYCARE PROVIDERS - IMMUNIZATION PAY-FOR-PERFORMANCE

IMMUNIZATION PAY-FOR-PERFORMANCE (P4P) PAYMENTS FOR JULY-SEPTEMBER 2006 HAVE BEEN ISSUED TO ELIGIBLE PCPS WHO REGISTERED FOR P4P PRIOR TO MARCH 12, 2007. IMPORTANT INFORMATION ON P4P PAYMENTS INCLUDING INSTRUCTIONS TO ACCESS THE P4P-SPECIFIC *PROVIDER REMITTANCE ADVICE STATEMENT* CAN BE FOUND AT WWW.LAMEDICAID.COM UNDER THE COMMUNITYCARE IMMUNIZATION PAY- FOR-PERFORMANCE (P4P) INITIATIVE LINK.

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ATTENTION PROVIDERS - FAMILY PLANNING WAIVER RECIPIENT INFORMATION

THE ANNUAL EPSDT RECIPIENT NOTICE WAS RECENTLY MAILED TO MEDICAID RECIPIENT HOUSEHOLDS WITH CHILDREN UNDER 21. THIS NOTICE WAS MAILED TO FAMILY PLANNING WAIVER RECIPIENTS IN ERROR. A RETRACTION NOTICE HAS BEEN MAILED TO THOSE FAMILY PLANNING WAIVER RECIPIENTS. PLEASE BE AWARE OF THIS ERROR, AND IN ORDER TO PREVENT PROVIDING NON-COVERED SERVICES TO A FPW RECIPIENT WHO MAY PRESENT THIS NOTICE WHEN SEEKING SERVICES, BE SURE TO CHECK RECIPIENT ELIGIBILITY TO ENSURE THAT THE RECIPIENT IS ELIGIBLE FOR EPSDT SERVICES.

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ATTENTION HOSPITAL PROVIDERS - SWALLOWING FUNCTION EVALUATIONS

EFFECTIVE FOR DATES OF SERVICE ON OR AFTER 1/1/2005, HCPC CODE 92520 WAS NO LONGER VALID FOR BILLING LARYNGEAL FUNCTION STUDIES AND REFERRED HOSPITALS TO BILL HCPC CODES 92610, 92611 AND 92612 FOR SPECIFIC SWALLOWING FUNCTION EVALUATION. AFTER REVIEW, DHH HAS MADE THESE CODES PAYABLE RETROACTIVE TO JANUARY 1, 2005. THESE CODES WILL ONLY BE
REIMBURSED WHEN BILLED UNDER REVENUE CODE HR 444. ALL TIMELY FILED CLAIMS BILLED UNDER REVENUE CODE HR 444 WHICH DENIED SINCE 2005 HAVE BEEN RECYCLED. PROVIDER RELATIONS MAY BE CONTACTED FOR ADDITIONAL INFORMATION.

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ATTENTION HOSPITALS - TREATMENT & OBSERVATION ROOM CHARGES

EFFECTIVE FOR DATES OF SERVICE ON OR AFTER MARCH 1, 2007, REVENUE CODES 760 AND 769 WILL NO LONGER BE VALID FOR THE BILLING OF EITHER TREATMENT OR OBSERVATION ROOM CHARGES.
WHEN BILLING FOR USE OF A TREATMENT ROOM, HOSPITALS ARE DIRECTED TO BILL REVENUE CODE 761 WITH THE APPROPRIATE HCPC CODE FOR THE SERVICE PROVIDED.

OBSERVATION ROOM CHARGES MUST BE BILLED UTILIZING REVENUE CODE 762 WITH THE APPROPRIATE HCPC CODE FOR THE SERVICE PROVIDED AND THE NUMBER OF UNITS PROVIDED. EACH UNIT REPRESENTS ONE HOUR OF OBSERVATION. HOSPITALS MUST INCLUDE THE ADMISSION HOUR AND DISCHARGE HOUR WHEN BILLING FOR THESE SERVICES ON ALL OUTPATIENT CLAIMS. POLICY MANDATES OUTPATIENT SERVICES EXCEEDING 24 HOURS IN DURATION ARE 'DEEMED' INPATIENT, EVEN IF THE PATIENT IS ADMITTED AS OUTPATIENT. THEREFORE CLAIMS WHICH INCLUDE OBSERVATION UNITS (HOURS) OF GREATER THAN 24 MUST BE BILLED AS INPATIENT AND CANNOT BE SPLIT BILLED AS INDIVIDUAL OUTPATIENT CLAIMS.