RA Messages for April 4, 2000
CLAIMS RECOVERY
CLAIMS WERE RECOVERED ON 01-08-2000 AS THE RESULT OF THE LOUISIANA DEDUCTIBLE AND COINSURANCE/OVERPAYMENTS PROJECT. DUE TO A PROGRAMMING
MISINTERPRETATION, THE PRIVATE CONTRACTOR FOR THIS PROJECT INCLUDED CLAIMS WHICH SHOULD HAVE BEEN ADJUSTED RATHER THAN VOIDED. IF YOUR CLAIMS WERE PART OF THIS PROJECT, YOUR 03-14-2000 REMITTANCE ADVICE REFLECTED AN AUDIT PAYMENT AMOUNT WHICH REPRESENTS A REFUND FOR THE DIFFERENCE BETWEEN THE AMOUNT RECOVERED AND THE AMOUNT WHICH SHOULD HAVE
BEEN RECOVERED. YOU MUST REFER TO THE PRINTOUTS ORIGINALLY SENT TO YOU BY THE DHH CONTRACTOR, HEALTH MANAGEMENT SYSTEMS, INC. IN ORDER TO IDENTIFY THE CLAIMS THAT SHOULD HAVE BEEN ADJUSTED.
PROCEDURE CODES
THE FOLLOWING PROCEDURE CODES HAVE BEEN LOADED TO RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS: 90748 EFFECTIVE JANUARY 1, 1998
AND 92551, 90632, 90633, 90634, 90645, 90646, 90648, 90657, 90658, 90659, 90669, 90680 EFFECTIVE JANUARY 1, 1999. IDENTIFY THE CLAIMS THAT SHOULD HAVE BEEN ADJUSTED.
COPYING MEDICAL RECORDS
A CLARIFICATION OF LOUISIANA MEDICAID POLICY HAS BEEN ISSUED REGARDING WHETHER OR NOT IT IS ACCEPTABLE FOR A PHYSICIAN TO CHARGE MEDICAID RECIPIENTS FOR PROVIDING A COPY OF THEIR MEDICAL RECORDS. IT IS ACCEPTABLE TO CHARGE RECIPIENTS WHEN BOTH OF THE FOLLOWING INSTANCES OCCUR: 1)THE PATIENT IS LEAVING THE PRACTICE, AND 2) THE PHYSICIAN TYPICALLY BILLS ALL PATIENTS FOR THIS SERVICES.
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 OUTPATIENT 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.
REMINDER TO ALL COMMUNITY CARE PROVIDERS
WHEN A MEDICAID RECIPIENT LINKED TO A COMMUNITY CARE PROVIDER NEEDS A MEDICALLY NECESSARY SERVICE THAT THE PCP DOES NOT PROVIDE (I.E. LAB, X-RAY, HOSPITAL ADMISSION, CARDIOLOGIST, ENT, ETC.) THE PCP MUST PROVIDE
A WRITTEN REFERRAL TO A SPECIALIST OR MEDICAL FACILITY PROVIDING THE SERVICE. THE WRITTEN REFERRAL SHOULD BE GIVEN TO THE RECIPIENT TO PRESENT TO THE SPECIALIST'S OFFICE AT THE TIME OF THE APPOINTMENT, OR THE PCP SHOULD MAIL OR FAX THE REFERRAL SO THAT THE SPECIALIST HAS THE
REFERRAL BY THE TIME THE SERVICE IS PROVIDED.
NOTICE TO ALL RURAL HEALTH CLINICS-FEDERALLY QUALIFIED HEALTH
CLINICS ENROLLED IN COMMUNITY CARE
MOST RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CLINICS WHICH ARE ENROLLED AS COMMUNITY CARE PROVIDERS HAVE ALREADY TRANSITIONED FROM BILLING UNDER THEIR PHYSICIAN GROUP NUMBER TO BILLING CHARGES UNDER THEIR
RHC/FQHC NUMBERS. THESE PROVIDERS ARE REMINDED THAT REFERRALS GIVEN FOR DATES OF SERVICE BEFORE THE TRANSITION MUST BE COMPLETED WITH
THE PHYSICIAN GROUP NUMBER. REFERRALS FOR DATES OF SERVICE AFTER THE TRANSITION MUST BE COMPLETED WITH THE RHC/FQHC NUMBER. STAFF SHOULD ALWAYS CHECK THE CP-O-92 FOR THE MONTH DURING WHICH THE SERVICE WAS PROVIDED TO CONFIRM THAT THE RECIPIENT WA ACTUALLY LINKED TO THAT PROVIDER FOR THAT MONTH. CHARGES BILLED WITH AN INCORRECT REFERRAL AUTHORIZATION NUMBER WILL DENY WITH AN ERROR CODE OF 106. QUESTIONS MAY BE DIRECTED TO COMMUNITY CARE STAFF AT (225)342-1304.