RA Messages for May 31, 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 5/15/00 VERSION OF APPENDIX A:  

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

PHARMACISTS AND PRESCRIBING PROVIDERS

RECENTLY, THE APPENDICES FOR PROVIDER MANUALS WERE MAILED TO YOU.  APPENDIX A INCLUDED ADDITIONS, DELETIONS AND REVISIONS TO THE FEDERAL UPPER LIMITS WHICH BECOME EFFECTIVE ON JUNE 1, 2000. WE HAVE RECEIVED NOTIFICATION FROM THE HEALTH CARE FINANCING ADMINISTRATION TO DELAY THE IMPLEMENTATION OF THE JUNE 1 FEDERAL UPPER LIMITS TO AUGUST 1, 2000. THEREFORE, THE GENERIC DESCRIPTIONS WITH JUNE 1 PRICES LISTED IN APPENDIX A WILL NOT BE IMPLEMENTED UNTIL AUGUST 1 OR OTHERWISE DIRECTED BY HCFA.         

NOTICE TO HOSPITALS AND HOME HEALTH AGENCIES

WE REALIZE, DUE TO THE EVERGREEN VS. DHH CASE, WE HAVE NOTIFIED HOSPITALS OF DIFFERENT SPLIT-BILLING PROCEDURES FOR DATES OF SERVICE MARCH 1, 8, AND 23 OF 2000, AS WELL AS NOTIFYING HOME HEALTH AGENCIES OF DIFFERENT PROCEDURES FOR REQUESTING PA AND BILLING OF HOME HEALTH SERVICES BEGINNING WITH DATES OF SERVICE 2/1/00.  DUE TO RECENT DEVELOPMENTS IN THIS CASE, UPON RECEIPT OF THIS NOTICE, BILLING PROCEDURES ARE AS FOLLOWS:

ALL LONG TERM CARE HOSPITALS AND ALL PRIVATE AND PUBLIC PSYCHIATRIC HOSPITALS, INCLUDING PSYCHIATRIC UNITS WITHIN PRIVATE AND PUBLIC ACUTE CARE HOSPITALS (EXCEPT CHARITY HOSPITALS) WILL BE REQUIRED TO SPLIT-BILL MEDICAID INPATIENT CLAIMS CASED ON DOS EFFECTIVE MARCH 8 AND 23, 2000. HOME HEALTH AGENCIES - FOR DOS 2/1/00 THROUGH 3/22/00, THE PROCEDURES FOR REQUESTING PA AND BILLING ARE THOSE OUTLINES IN OUR PROVIDER NOTICE DATED 1/24/2000. IN SHORT, DURING THESE DOS ONLY, THE FIRST HOUR OF EXTENDED CARE MUST BE INCLUDED IN THE PA REQUEST FOR EXTENDED CARE FOR RECIPIENTS TO AGE 21. THE FEES DURING THOSE DOS ARE ALSO INCLUDED IN THIS NOTICE. FOR DOS 3/23/00 FORWARD, THE PROCEDURES FOR REQUESTING PA AND BILLING FOR THE 1ST HOUR OF EXTENDED ARE REMAINS THE SAME AS THOSE IN PLACE PRIOR TO 2/1/00, WHEN SERVICES ARE PROVIDED BY A PHYSICAL THERAPIST ASSISTANT OR AN LPN, THESE SERVICES ARE TO BE INDENTIFIED BY USING THE NEW CODES WHEN REQUESTING PA AND IN BILLING.

WE ARE SORRY  FOR THE INCONVEINEINCE. CONTACT UNISYS PROVIDER RELATIONS AT (800) 473-2783 OR (225) 924-5040 IF FURTHER ASSISTANCE IS REQUIRED.

ALL PROVIDERS

CLAIMS WERE RECOVERED ON 1/18/2000 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 THE THIS PROJECT, YOUR REMITTANCE ADVICE WILL REFLECT AN AUDIT PAYMENT AMOUNT WHICH REPRESENTS AN ADDITIONAL REFUND FOR CROSSOVER CLAIMS. THE AMOUNT OF THE PAYMENT IF THE DIFFERENCE BETWEEN THE CROSSOVER CLAIM AMOUNTS RECOVERED AND THE CROSSOVER CLAIMS AMOUNTS 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 CLAIMS THAT SHOULD HAVE BEEN ADJUSTED.