RA Messages for April 5, 2005

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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. 

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ATTENTION KIDMED AND PREVENTIVE MEDICINE PROVIDERS

A DHH EMERGENCY RULE REQUIRES ALL MEDICAID PROVIDERS SUBMITTING KIDMED/ PREVENTIVE MEDICINE CLAIMS TO SUBMIT DETAIL CLAIM DATA INCLUDING THE ACTUAL SCREENING AND IMMUNIZATION STATUS; SUSPECTED CONDITIONS; AND REFERRAL INFORMATION RELATED TO SUSPECTED CONDITIONS. THIS REQUIREMENT APPLIES TO BOTH ELECTRONIC AND PAPER CLAIMS. ELECTRONIC 837P KIDMED TRANSACTIONS MUST INCLUDE THE K3 SEGMENT, AND THE "FILE EXTENSION" MUST BE KID, NOT PHY. PROVIDERS BILLING PAPER CLAIMS USING THE CMS 1500 CLAIM FORM WITH ONLY THE SCREENING CODES MUST NOW SUBMIT THE KM-3 CLAIM FORM WITH ALL DETAIL INFORMATION. EDUCATIONAL EDITS (517 AND 518 OR HIPAA ADJUSTMENT REASON CODE 16 FOR 835 ELECTRONIC RA) CURRENTLY APPEAR ON ANY ELECTRONIC AND HARD COPY CLAIMS PAYMENTS IF ALL APPLICABLE KIDMED CLAIM DETAIL IS NOT PROVIDED. EFFECTIVE APRIL 1, 2005, EDITS 517(KIDMED FORMAT REQUIRED - CLAIM MUST BE SUBMITTED ON KIDMED FORMAT), 518(KIDMED INFORMATION MISSING - IMMUNIZATION AND SUSPECTED CONDITION INFORMATION REQUIRED) AND HIPAA REASON CODE 16 WILL DENY CLAIMS THAT ARE SUBMITTED ON THE 837P OR THE CMS 1500 CLAIM FORM WITHOUT KIDMED DETAIL.

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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. 

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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. 

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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.