RA Messages for April 18, 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 FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

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.

NOTICE TO HOSPITALS

EFFECTIVE APRIL 15, 2000, IT IS MANDATORY THAT HOSPITALS INCLUDE THE REVENUE CODE WITH THE HCPCS CODE WHEN REQUESTING PRIOR AUTHORIZATION OF  OUPATIENT HOSPITAL REHABILITATION SERVICES. IF THE PA REQUEST DOES NOT INCLUDE THE REVENUE CODE, THE REQUEST WILL BE RETURNED TO THE PROVIDER. IF FURTHER QUESTIONS ARISE, YOU MAY CALL UNISYS PROVIDER RELATIONS AT 1-800-473-2783 OR (225)924-5040. 

KIDMED PROVIDERS

KIDMED PROVIDERS SHOULD FOLLOW THE MOST CURRENT COPY OF THE AAP, ACIP, AND AAFP RECOMMENDED CHILDHOOD IMMUNIZATION SCHEDULE. THIS SCHEDULE SHOULD BE REPLACED BY KIDMED PROVIDERS EACH YEAR AS REVISIONS ARE PUBLISHED. 

NOTICE TO HOSPITALS

WHEN DETERMINING DISCHARGE FOR A RECIPIENT, THE TIME THE PHYSICIAN WROTE THE ORDER SHOULD BE USED. 

NOTICE TO HOME HEALTH AGENCIES

RECENTLY YOU WERE NOTIFIED OF NEW BILLING PROCEDURES FOR HOME HEALTH  SERVICES, EFFECTIVE WITH DATE OF SERVICE FEBRUARY 1, 2000. TO COMPLY WITH THE TEMPORARY RESTRAINING ORDER ISSUED IN THE EVERGREEN VS DHH CASE EFFECTIVE WITH DATE OF SERVICE MARCH 23, 2000, BILLING PROCEDURES AND POLICY IN EFFECT PRIOR TO FEBRUARY 1, 2000 HAVE BEEN REINSTATED. THE NEW BILLING PROCEDURES IN EFFECT DURING THE PERIOD FEBRUARY 1, 2000 THROUGH MARCH 22, 2000, REMAIN ACTIVE FOR THOSE DATES OF SERVICE. CLAIMS FOR DATES OF SERVICE MARCH 23, 2000 FORWARD THAT WERE VOIDED BY UNISYS ON THE APRIL 11, 2000 REMITTANCE ADVICE MAY BE RESUBMITTED FOR PROCESSING USING THE BILLING PROCEDURES AND POLICY IN EFFECT PRIOR TO FEBRUARY  1, 2000. 

NOTICE TO HOSPITALS

SPLIT-BILLING REQUIREMENTS DUR TO TEMPORARY RESTRAINING ORDER ISSUED IN THE EVERGREEN VS DHH CASE RAISING PER DIEMS EFFECTIVE MARCH 23, 2000. ALL LONG TERM CARE HOSPITALS AND ALL PRIVATE AND PUBLIC PSYCHIATRIC HOSPITALS, INCLUDING PSYCHIATRIC UNITS WITHIN PRIVATE AND PUBLIC ACUTE CARE HOSPITALS WILL BE REQUIRED TO SPLIT-BILL MEDICAID INPATIENT CLAIMS BASED ON DATE OF SERVICE ALSO, ALL ACUTE CARE HOSPITALS (EXCEPT CHARITY HOSPITALS) WILL BE REQUIRED TO SPLIT-BILL MEDICAID INPATIENT CLAIMS BASED ON DATE OF SERVICE EFFECTIVE MARCH 23, 2000 (ONE-TIME ONLY). IN ADDITION, CLAIMS VOIDED BY UNISYS ON THE APRIL 11, 2000 REMITTANCE FOR DATE OF SERVICE INCLUDING MARCH 23, 2000 AND FORWARD MAY BE  RESUBMITTED FOR PROCESSING UTILIZING THE SPLIT-BILLING PROCEDURES OUTLINED ABOVE.