RA Messages for May 22, 2007
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 THAT MAY HAVE BEEN INCORRECTLY
PAID. ONLY THOSE PRODUCTS OF THE MANUFACTURERS WHICH PARTICIPATE IN THE FEDERAL
REBATE PROGRAM WILL BE COVERED BY THE MEDICAID PROGRAM. PARTICIPATION MAY BE
VERIFIED IN APPENDIX C, AVAILABLE AT
WWW.LAMEDICAID.COM
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.
ATTENTION ASSISTANT SURGEONS
PROCEDURE CODE 36819 (ARTERIOVENOUS
ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION) HAS BEEN
MADE PAYABLE EFFECTIVE JULY 1, 2006 FOR ASSISTANT SURGEONS. CLAIMS FOR
ASSISTANT SURGEON SERVICES FOR THIS PROCEDURE FOR DATES OF SERVICE JULY
1, 2006 FORWARD MAY BE SUBMITTED TO UNISYS FOR ADJUDICATION.
ATTENTION PROVIDERS - UPDATE ON
STERILIZATION CONSENT FORMS
THE OFFICE OF POPULATION AFFAIRS (OPA)
HAS UPDATED THE STERILIZATION CONSENT FORM AVAILABLE ON THEIR
CLEARINGHOUSE WEBSITE WHICH INCLUDES THE REVISED EXPIRATION DATE OF THE
FORM. PROVIDERS ARE STRONGLY ENCOURAGED TO USE THE MOST CURRENT
STERILIZATION CONSENT FORM FROM THIS SITE. THE OPA WEBSITE ADDRESS IS:
HTTP://OPA.OSOPHS.DHHS.GOV/PUBS/PUBLICATIONS.HTML
(LOWERCASE LETTERS MUST BE USED TO ACCESS THE SITE)
ATTENTION ALL PROVIDERS
CMS HAS EXTENDED THE ENFORCEMENT OF
THE RULE MANDATING MAY 23, 2007 AS THE IMPLEMENTATION DATE FOR THE USE
OF NPI ONLY FOR CLAIMS SUBMISSIONS. DHH AND UNISYS HAVE DETERMINED THAT
ADDITIONAL TIME IS NEEDED TO IMPLEMENT AND TEST SYSTEM CHANGES TO ENSURE
CORRECT AND TIMELY PAYMENT OF CLAIMS WITH NPI SUBMITTED TO LA MEDICAID.
THUS, WE WILL NOT IMPLEMENT THE USE OF NPI FOR LA MEDICAID CLAIMS
PROCESSING ON MAY 23, 2007. PLEASE REFER TO THE LA MEDICAID WEB SITE,
WWW.LAMEDICAID.COM, FOR FURTHER
INFORMATION.