RA Messages for May 21, 2002
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 FILE ADJUSTMENTS FOR
CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.
NOTICE TO ALL PROVIDERS
THE CONTRACT "PROVIDER'S ELECTION TO EMPLOY ELECTRONIC MEDIA SUBMISSION OF CLAIMS FOR PROCESSING IN THE LOUISIANA MEDICAL ASSISTANCE PROGRAM"
WAS REVISED IN AUGUST 2001. EFFECTIVE JUNE 3, 2002, PROVIDER ENROLLMENT WILL NO LONGER ACCEPT ANY VERSION OF THIS CONTRACT WITH A REVISION DATE
PRIOR TO AUGUST 2001. ALL REQUESTS SUBMITTED ON OUTDATED CONTRACTS WILL BE RETURNED TO YOU WITH THE CORRECT FORMS FOR RESUBMISSION. IF YOU NEED
TO OBTAIN AN UPDATED COPY, PLEASE CALL THE EMC DEPARTMENT AT (225) 237- 3200, EXT. 2.
PHYSICIANS AND HOSPITALS, INPATIENT AND OUTPATIENT, AND ANESTHESIA
PROVIDERS
UNISYS PROVIDER RELATIONS HAS RECEIVED QUESTIONS CONCERNING THE DENIAL 478 (SEND WRITTEN SONOGRAM RESULTS WITH OPERATIVE REPORT, PATHOLOGY
REPORT AND HISTORY.) WHEN A D&C IS DONE FOR AN INCOMPLETE OR MISSED ABORTION AND ERROR 478 IS RECEIVED, THE REVIEW TEAM MUST HAVE
DOCUMENTATION TO SUBSTANTIATE THAT THE FETUS WAS NOT LIVING AT THE TIME OF THE D&C; THAT IS, THAT THIS WAS NOT AN ABORTION FOR PREGNANCY
TERMINATION. THIS DOCUMENTATION MAY BE (1)A SONOGRAM REPORT SHOWING NO FETAL HEART TONES; (2) A HISTORY SHOWING PASSAGE OF FETUS AT HOME, IN
AN AMBULANCE, OR IN THE EMERGENCY ROOM; (3) A PATHOLOGY REPORT SHOWING DEGENERATING PRODUCTS OF CONCEPTION; OR (4) AN OPERATIVE REPORT
SHOWING PRODUCTS OF CONCEPTION IN THE VAGINA. ALL REPORTS ARE NOT NEEDED.
THESE ARE EXAMPLES OF THE INFORMATION NEEDED TO PROVIDE ENOUGH DOCUMENTATION TO PROPERLY REVIEW THE CLAIM AND SUBSTANTIATE PAYMENT.
NOTICE TO COMMUNITYCARE PCPS
THE SYSTEM IS CURRENTLY IN THE PROCESS OF BEING PROGRAMMED TO REIMBURSE ENHANCED RATES FOR SELECTED CPT CODES. AS SOON AS THIS PROGRAMMING IS
COMPLETE, CLAIMS WITH EFFECTIVE DATES OF SERVICE APRIL 1, 2002 AND FORWARD, WHICH WERE PAID AT FEE SCHEDULE RATES, WILL BE RECYCLED.
NOTICE TO COMMUNITYCARE PROVIDERS
THIS IS TO REMIND ALL COMMUNITYCARE PCPS THAT PAYMENT OF COMMUNITYCARE MANAGEMENT FEES IS MADE AFTER THE SIGNATURE SHEET FROM THE MONTHLY
CP-O-92 IS SUBMITTED TO UNISYS FOR PAYMENT AT THE END OF THE MONTH. THE RULES FOR TIMELY FILING APPLY TO THESE MANAGEMENT FEES AS THEY DO TO ALLCLAIMS, IN THAT THEY MUST BE FILED WITHIN ONE YEAR FROM THE DATE OF
SERVICE, WHICH IS THE FIRST DAY OF THE MONTH. PROVIDERS SHOULD, THEREFORE, SUBMIT SIGNATURE SHEETS AND CONFIRM RECEIPT OF PAYMENT FOR
EACH MONTH IN A TIMELY MANNER, IN ORDER TO AVOID DENIALS BECAUSE OF
FAILURE TO FILE TIMELY.
AN ADDITIONAL REMINDER - PROVIDER SHOULD KEEP A COPY OF EACH SIGNATURE
PAGE WITHOUT THE SIGNATURE. IF PAYMENT IS NOT RECEIVED FOR ANY MONTH,
AN ORIGINAL SIGNATURE CAN BE PLACED ON THE COPY OF THE SIGNATURE SHEET,
AND IT CAN BE RESUBMITTED TO UNISYS FOR PAYMENT.
QUESTIONS REGARDING THIS MATTER MAY BE DIRECTED TO UNISYS PROVIDER
RELATIONS AT 1-800-473-2783.