RA Messages for May 2, 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 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

WHEN DETERMINING DISCHARGE FRO 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 DUE 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 EFFECTIVE MARCH 23, 2000 (ONE-TIME P=ONLY).  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 OUTLINES ABOVE.