RA Messages for June 19, 2007

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ATTENTION PROVIDERS

EFFECTIVE 7-2-2007, IN ACCORDANCE WITH A RECENT DHH DIRECTIVE, UNISYS WILL NO LONGER ACCEPT COPIES OF STANDARD CLAIM FORMS, THE REGULATIONS DO NOT ALLOW THE COPYING OF HARDCOPY CLAIM FORMS. THESE INCLUDE THE UB-92, UB-04, CMS 1500 (12-90), CMS 1500 (08-05), ADA, AND THE NCPDP UNIVERSAL CLAIM FORM. ANY HARD COPY CLAIMS SUBMITTED TO UNISYS FOR PROCESSING MUST BE AN ORIGINAL, STANDARD CLAIM FORM AND MUST MEET THE LICENSURE/ COPYRIGHT REQUIREMENTS OF THE PARTICULAR ORGANIZATION THAT REGULATES THAT CLAIM FORM. THIS INCLUDES ORIGINAL SUBMISSIONS, RE-SUBMISSIONS OF PREVIOUS CLAIMS, AND CLAIM ADJUSTMENTS/VOIDS.

WITH THE IMPLEMENTATION OF THIS REQUIREMENT, PROVIDERS THAT ARE ROUTINELY BILLING ALL CLAIMS HARD COPY MAY WANT TO CONSIDER TRANSITIONING TO ELECTRONIC CLAIMS SUBMISSION. QUESTIONS CONCERNING EDI BILLING MAY BE DIRECTED TO THE UNISYS EDI DEPARTMENT AT 225/216-6000, OPTION 2. A COMPLETE LISTING OF APPROVED EDI VENDORS IS AVAILABLE ON THE LA MEDICAID WEB SITE, WWW.LAMEDICAID.COM, LINK HIPAA INFORMATION CENTER/LINK VBC LIST. PLEASE CONTACT THE VENDORS FOR SPECIFIC INFORMATION ON THEIR SERVICES AS A WIDE RANGE OF PACKAGES/FEES ARE AVAILABLE.

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ATTENTION PROFESSIONAL SERVICES PROVIDERS

BASED ON FUNDING APPROPRIATED IN THE 2006 LEGISLATIVE SESSION AND APPROVAL BY CMS, DHH IS PLEASED TO ANNOUNCE INCREASES IN THE REIMBURSEMENT RATE FOR SELECTED GROUPS OF CPT PROCEDURE CODES, INCLUDING CERTAIN OUTPATIENT EVALUATION AND MANAGEMENT, EMERGENCY DEPARTMENT, OUTPATIENT CONSULTATION, PREVENTIVE MEDICINE, AND GENERAL/ INTEGUMENTARY SYSTEM CODES. THE INCREASES ARE EFFECTIVE WITH DATE OF SERVICE OCTOBER 4, 2006, FORWARD.

CLAIMS PAID AT THE LOWER RATE WILL BE SYSTEMATICALLY RECYCLED. DUE TO THE LARGE CLAIMS VOLUME, THE RECYCLE WILL OCCUR IN THREE WEEKLY CYCLES, IN NUMERICAL ORDER BY BILLING PROVIDER NUMBER, BEGINNING WITH THE RA OF JUNE 12, 2007. CLAIMS FOR BILLING PROVIDERS WILL APPEAR ON ONLY ONE OF THE THREE RAS. PLEASE REVIEW YOUR RAS TO DETERMINE WHICH DATE YOUR CLAIMS WERE RECYCLED.

THESE RATE INCREASES WILL ALSO BE REFLECTED ON THE PROFESSIONAL SERVICES FEE SCHEDULE POSTED ON THE LA MEDICAID WEB SITE, WWW.LAMEDICAID.COM, LINK FEE SCHEDULES.

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HOSPITALS - AMBULATORY SURGERY PROGRAMMING UPDATES

EFFECTIVE FOR DATES OF SERVICE ON OR AFTER 4/1/07, THE FOLLOWING CHANGES HAVE BEEN MADE TO PROGRAMMING/REIMBURSEMENT OF CLAIMS SUBMITTED FOR AMBULATORY SURGERY:
- AMBULATORY SURGERY CLAIMS ARE NOT TO BE BILLED AS SINGLE LINE CLAIMS. ALL CLAIMS BILLED AS OF THIS DATE WITHOUT DETAIL BILLING WILL BE DENIED WITH ERROR 539 (CLAIM REQUIRES DETAILED BILLING). PAID CLAIMS ARE BEING SYSTEMATICALLY VOIDED. PROVIDERS ARE ASKED TO CORRECT AND RESUBMIT THESE CLAIMS.
- IF MULTIPLE HR490'S ARE BILLED, THE SYSTEM WILL DETERMINE THE HIGHEST REIMBURSED HCPC CODE AND PAY THAT AMOUNT.
- WHEN THE BILLED CHARGES LINE FOR THE HR490 IS LESS THAN THE HCPC GROUP RATE, THE SYSTEM WILL DETERMINE THE LESSER OF TOTAL BILLED CHARGES FOR THE ENTIRE CLAIM OR THE HCPC GROUP RATE AND REIMBURSE THAT AMOUNT.

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ATTENTION PROVIDERS

EFFECTIVE 6-4-07, THE CMS 1500(12-90) CLAIM FORM BECAME OBSOLETE FOR BILLING CLAIMS TO LA MEDICAID, AND UNISYS BEGAN REJECTING THOSE FORMS. PROVIDERS MUST USE THE REVISED CMS 1500(08-05)FOR ALL CLAIM SUBMISSIONS, INCLUDING DATES OF SERVICE PRIOR TO 6-4-07. REJECTION OF CLAIMS DELAYS YOUR PAYMENT AND DOES NOT SERVE AS PROOF OF TIMELY FILING. PLEASE MAKE THE NECESSARY CHANGES IN YOUR INTERNAL PROCEDURES TO ENSURE THAT YOU ARE USING THE CORRECT FORM. ALL PROVIDERS BILLING ON THE CMS 1500 CLAIM FORM MUST USE THE REVISED FORM FOR ANY AND ALL SUBMISSIONS.

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ATTENTION PROVIDERS

UNISYS CONTINUES TO REJECT OVER 250,000 CLAIMS YEARLY FOR BASIC BILLING REQUIREMENTS. IF YOU MUST BILL HARD COPY, PLEASE ENSURE THAT YOU ARE FOLLOWING THE NECESSARY INSTRUCTIONS FOR BILLING YOUR SPECIFIC CLAIMS. IF YOU DO NOT BILL CLAIMS ELECTRONICALLY, PLEASE CONSIDER THIS OPTION FOR EFFICIENCY IN CLAIM SUBMISSIONS AND TO ASSIST WITH EXPEDITING PAYMENTS. PLEASE CONTACT THE UNISYS EDI DEPARTMENT AT (225) 216-6000, OPTION 2 TO DISCUSS ELECTRONIC BILLING ALTERNATIVES.