RA Messages for May 7, 2002

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 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.

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PLEASE MAKE THE FOLLOWING CHANGES TO THE 1/1/02 VERSION OF APPENDIX C:

 PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE MAY 1, 2002, CODE J7302 FOR MIRENA, THE  LEVONORGESTREL-RELEASING INTRUTERINE SYSTEM, WILL BECOME PAYABLE TO PHYSICIANS AT $337.17 PER SYSTEM FOR FEMALES WHO OBTAIN THE SYSTEM IN THE PHYSICIAN'S OFFICE. THIS FEE INCLUDES $35.00 FOR INSERTION. 

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE APRIL 1, 2002, THE FOLLOWING CPT CODES WILL DENY IF BILLED WITHOUT A QW MODIFIER: 
82523 - COLLAGEN CROSS LINKS, ANY METHOD 
82679 - ESTRONEJ 
83002 - GONADOTROPIN; LUTEINIZING HORMONE 
83605 - LACTATE 
86294 - IMMUNOASSAY FOR TUMOR ANTIGEN, QUALITATIVE OR SEMIQUANTITATIVE 
86618 - ANTIBODY; BORRELIA BURGDORFERI 
87077 - CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE 
87449 - INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE OR SEMIQAUNTITATIVE; MULTIPLE STEP METHOD, NOT OTHERWISE SPECIFIED, EACH ORGANISM 
87804 - INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA 
89300 - SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM INCLUDING HUHNER TEST (POST COITAL)

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REMINDER REGARDING RECIPIENTS WITH TPL COVERAGE

THE UNISYS PROVIDER RELATIONS CORRESPONDENCE UNIT IS RECEIVING NUMEROUS REQUESTS TO UPDATE TPL INFORMATION AS WELL AS ASSIGN A SIX-DIGIT TPL CARRIER CODE FOR THESE COMPANIES. IN MANY OF THESE CASES,THE INFORMATION IS AND HAS BEEN ON FILE FOR SOME TIME. PLEASE REMEMBER THAT PROVIDERS SHOULD CHECK RECIPIENT ELIGIBILITY WHICH INCLUDES THE RECIPIENT'S TPL SEGMENT THROUGH MEVS AND/OR REVS TO OBTAIN OR VERIFY THE NAME OF THE THIRD-PARTY INSURANCE CARRIER AND THE ASSOCIATED TPL CODE. (PROVIDERS ARE MAILED A TPL LISTING AT THE BEGINNING OF THE YEAR. THE LISTING IS UPDATED MIDYEAR.) THE CARRIER CODE AND TPL PAYMENT SHOULD BE PLACED IN THE APPROPRIATE BOX OF YOUR CLAIM FORM. FOR QUESTIONS OR CONCERNS, PLEASE CONTACT PROVIDER RELATIONS AT 1-800-473-2783. 

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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. 

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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.