RA Messages for June 13, 2005

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NOTICE TO ALL PROVIDERS

CLARIFICATION OF "CHANGES IN BILLING PROCEDURES AND REIMBURSEMENT FOR CNP'S, CNS'S, AND CNM'S" ARTICLE IN THE MARCH/APRIL 2005 LOUISIANA MEDICAID PROVIDER UPDATE 

IT HAS COME TO THE DEPARTMENT'S ATTENTION THAT CLARIFICATION REGARDING THE CONTENT OF THIS ARTICLE IS NEEDED. THE "CHANGE" IN BILLING FOR THESE PRACTITIONERS EFFECTIVE JULY 1, 2005, IS THAT THERE WILL NO LONGER BE A
"LIST" OF BILLABLE SERVICES. INSTEAD THE SERVICES COVERED WILL BE DETERMINED BY INDIVIDUAL LICENSURE, SCOPE OF PRACTICE, AND COLLABORATIVE AGREEMENT (UNLESS OTHERWISE EXCLUDED BY LOUISIANA MEDICAID). LOUISIANA MEDICAID'S LONG-STANDING POLICY OF REQUIRING CNP'S AND CNS'S TO OBTAIN AN INDIVIDUAL PROVIDER NUMBER AND TO INDICATE THE SERVICES PROVIDED BY THESE PRACTITIONERS BE IDENTIFIED ON THE CMS-1500 CLAIM FORM IN BLOCK 24K (ATTENDING PROVIDER) HAS NOT CHANGED. PLEASE SEE PAGE 16 OF THE 2004 PROFESSIONAL SERVICES TRAINING MANUAL FOR FURTHER INFORMATION. THE LIST OF CODES PAYABLE TO CNP'S AND CNS'S IS FOUND IN APPENDIX C OF THE SAME MANUAL. 

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ATTENTION PHYSICIANS

SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENTS, PER UNIT DOSE DELETED CPT CODE 78990 HAS BEEN PLACED IN NON-PAY STATUS EFFECTIVE JULY 1, 2005. HCPCS CODES A9500 AND A9502 HAVE BEEN MADE PAYABLE EFFECTIVE JANUARY 1, 2005, AT 80% OF THE REGION 99 MEDICARE ALLOWABLE, BASED ON THE FEE PER UNIT DOSE. CLAIMS FOR THESE IMAGING AGENTS MAY NOW BE SUBMITTED ELECTRONICALLY AS AN INVOICE WILL NO LONGER BE REQUIRED. 

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NOTICE TO ACUTE CARE HOSPITALS

EFFECTIVE APRIL 21, 2005, ROUTINE CIRCUMCISIONS ARE NO LONGER A COVERED MEDICAID SERVICE IN EITHER INPATIENT OR OUTPATIENT SETTINGS, HOWEVER, ALL MEDICALLY NECESSARY CIRCUMCISIONS WILL CONTINUE TO BE PAYABLE. CHARGES ASSOCIATED WITH NON-MEDICALLY NECESSARY CIRCUMCISIONS MUST BE 
IDENTIFIED AS NON-COVERED CHARGES. 

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ATTENTION DENTAL PROVIDERS

A MEDICAID DENTAL PROVIDER CANNOT LIMIT HIS PRACTICE TO DIAGNOSTIC AND PREVENTIVE SERVICES ONLY. A DENTAL PROVIDER WHO ONLY OFFERS DIAGNOSTIC AND PREVENTIVE SERVICES IN HIS PRACTICE DOES NOT MEET THE NECESSARY CRITERIA FOR PARTICIPATION IN THE MEDICAID EPSDT DENTAL, ADULT DENTURE OR EXPANDED DENTAL SERVICES FOR PREGNANT WOMEN (EDSPW) PROGRAMS. DENTAL SERVICES REQUIRING TREATMENT BY A SPECIALIST MAY BE REFERRED TO ANOTHER PROVIDER WHO CAN ADDRESS THE SPECIFIC TREATMENT; HOWEVER, THE RECIPIENT OR GUARDIAN, AS APPROPRIATE, MUST BE ADVISED OF THE REFERRAL. THE REIMBURSEMENT MADE FOR THE EXAMINATION, PROPHYLAXIS, BITEWING RADIOGRAPHS AND FLUORIDE TO PROVIDERS WHO ROUTINELY REFER RECIPIENTS FOR 
RESTORATIVE, SURGICAL AND OTHER TREATMENT SERVICES IS SUBJECT TO 
RECOUPMENT. SHOULD YOU HAVE ANY QUESTIONS, YOU MAY CONTACT TERRI NORWOOD, DENTAL PROGRAM SPECIALIST, BY CALLING 225-342-9403. 

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ATTENTION ALL ELECTRONIC CLAIM SUBMITTERS

ONCE THE NEW ANNUAL CERTIFICATION FORM IS ON FILE FOR 2005, INDIVIDUAL CERTIFICATION FORMS FOR EACH FILE TRANSMISSION ARE NO LONGER REQUIRED. 

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ATTENTION ALL ELECTRONIC CLAIM SUBMITTERS

THE DEADLINE HAS PASSED. PLEASE ENSURE THAT YOUR 2005 ANNUAL CERTIFICATION FORM IS COMPLETED AND SUBMITTED TO UNISYS. FOR ADDITIONAL INFORMATION, PLEASE CONTACT THE EDI HELP DESK AT 225-237-3303.

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ATTENTION DENTAL PROVIDERS

DENTAL CLAIMS THAT WERE IDENTIFIED HAS HAVING BEEN INADVERTENTLY DENIED WITH ERROR CODE 233 (PROCEDURE/NDC NOT COVERED FOR SERVICE DATE GIVEN) WERE RECYCLED BY MEDICAID AND APPEARED ON THE REMITTANCE ADVICE DATED MAY 31, 2005.  IF YOU HAVE ANY UNPAID DENTAL CLAIMS THAT INADVERTENTLY DENIED WITH ERROR CODE 233 THAT WERE NOT INCLUDED IN THIS RECYCLE, PLEASE RESUBMIT THE CLAIM(S) TO UNISYS AS SOON AS POSSIBLE.  PLEASE REMEMBER TO INCLUDE PROOF OF TIMELY FILING IF THE DATE OF SERVICE IS OVER 1 YEAR.  PLEASE CALL UNISYS PROVIDER RELATIONS WITH ANY QUESTIONS AT (800) 473-2783 OR (225) 924-5040.