RA Messages for May 4, 2004

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ATTENTION ALL MEDICAID PROVIDERS

AS OF DECEMBER 1, 2003, THE COMMUNITYCARE PROGRAM HAS BEEN IMPLEMENTED STATEWIDE. APPROXIMATELY 80% OF ALL MEDICAID ELIGIBLES ARE ENROLLED IN COMMUNITYCARE AND ARE LINKED TO A COMMUNITYCARE PRIMARY CARE PHYSICIAN (PCP). THEREFORE, THE COMMUNITYCARE PROGRAM IMPACTS THE REIMBURSEMENT AND PRACTICE OF ALL MEDICAID PROVIDERS IN EVERY AREA OF THE STATE, NOT JUST COMMUNITYCARE-ENROLLED PCPS. ALL MEDICAID PROVIDERS SHOULD BECOME FAMILIAR WITH THE PROGRAM, AND READ ALL REMITTANCE MESSAGES AND PROVIDER UPDATE ARTICLES CONCERNING COMMUNITYCARE. 

PROVIDERS CAN FIND OUT WHICH PCP A PATIENT IS LINKED TO WHEN THEY CHECK THE PATIENT'S MEDICAID ELIGIBILITY USING ANY OF THE MEDICAID ELIGIBILITY VERIFICATION SYSTEMS, IE; REVS, MEVS AND THE WEB APPLICATION (EMEVS). THIS INFORMATION SHOULD ALWAYS BE CHECKED PRIOR TO PROVIDING NON- EMERGENT SERVICES TO ANY MEDICAID RECIPIENT. IF THERE IS NOT A PCP LISTED, THEN THE PATIENT IS NOT IN COMMUNITYCARE, AND A PCP REFERRAL IS NOT NEEDED.

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ATTENTION COMMUNITYCARE/KIDMED PROVIDERS

AS WE HAVE MOVED FROM HARD COPY CP-0-92 AND RS-0-07 REPORTS TO ELECTRONIC ON-LINE REPORTS FOR PROVIDER RETRIEVAL, WE HAVE RECEIVED A NUMBER OF PROVIDER CALLS INDICATING THAT THE UNISYS WATERMARK ON EACH PAGE IS CAUSING EXTENDED PRINTING TIME AND CAUSING INFORMATION ON THE PAGE TO BE UN-READABLE BECAUSE THE WATERMARK PRINTS TOO DARK.  AS A RESULT OF YOUR CONCERNS, THE WATERMARK IS BEING REMOVED FROM THE REPORT PAGES.  THIS CHANGE WILL TAKE PLACE FOR THE MAY 2004 REPORT.

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ATTENTION DME AND PHARMACY PROVIDERS

OUR PROGRAM INTEGRITY STAFF HAVE BEEN CONDUCTING FIELD AUDITS ON DURABLE MEDICAL EQUIPMENT PROVIDERS AND HAS FOUND IN SOME CASES, THE PROVIDER IS NOT MAINTAINING A COPY OF THE PRIMARY CARE PHYSICIAN'S REFERRAL. THIS IS A REQUIREMENT UNDER THE COMMUNITYCARE PROGRAM. FAILURE TO MAINTAIN A COPY OF A REFERRAL IS GROUNDS FOR RECOUPMENT OF MONEY PAID FOR SERVICES, EQUIPMENT AND SUPPLIES, AS WELL AS IMPOSITION OF OTHER SANCTIONS AS A RESULT OF THE PROVIDER NOT ADHERING TO MEDICAID POLICY. 

IT IS NOT NECESSARY TO HAVE A REFERRAL FROM THE PRIMARY CARE PHYSICIAN PRIOR TO SUBMITTING A REQUEST FOR AUTHORIZATION OF PAYMENT TO THE PRIOR AUTHORIZATION UNIT (PAU). HOWEVER, A REFERRAL MUST BE OBTAINED AND MAINTAINED ON FILE PRIOR TO BILLING, SINCE ALL CONDITIONS REQUIRED FOR PAYMENT MUST BE MET PRIOR TO BILLING.

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NOTICE TO PROVIDER OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2003.  THE FOLLOWING CPT CODES WILL BE ADDED TO THE LIST OF CODES PAYABLE TO AUDIOLOGISTS.

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92543

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