RA Messages for June 29, 2004

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NOTICE TO PROVIDER OF PROFESSIONAL SERVICES

AS PER MEDICARE POLICY, THE FOLLOWING CODES HAVE BEEN MADE PAYABLE EFFECTIVE 01-01-2004 FOR CROSSOVERS ONLY.

G0317 - DIALYSIS, 4 OR MORE VISITS PER MONTH - $289.72
G0318 - DIALYSIS, 2-3 VISITS PER MONTH - $241.19
G0319 - DIALYSIS, 1 PHYSICIAN VISIT PER MONTH - $192.67
G0323 - MANAGEMENT OF HOME DIALYSIS (ENTIRE MONTH) - $241.19
G0327 - MANAGEMENT OF HOME DIALYSIS (PARTIAL MONTH ONLY) - $8.22

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ATTENTION HOME HEALTH PROVIDERS

PRIOR TO HIPAA, WHEN AN AGENCY BILLED FOR EXTENDED SKILLED NURSING SERVICES (HOME HEALTH), AGENCIES USED THE CODES X9902 AND X9907 (MULTI-RECIPIENTS). IT DID NOT MATTER WHO PERFORMED THE SERVICE, RN OR LPN, AS THEY WERE PAID AT THE SAME RATE.

WITH HIPAA, MEDICAID MAPPED TO 2 SEPARATE CODES (S9123 FOR RN AND S9124 FOR LPN). THE ONLY TIME AN AGENCY NEEDS TO USE A MODIFIER IS IF THERE ARE MULTI-RECIPIENTS. AT THE TIME, THE AGENCY WOULD REQUEST AND BILL A TT MODIFIER.

AS PER THIS NOTICE, PRIOR AUTHORIZATION REQUESTS FOR S9123 OR S9124 WILL BE DENIED IS ANY MODIFIER OTHER THAN TT IS REQUESTED.

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ATTENTION ALL DENTAL PROVIDERS 

DUE TO SYSTEM PROBLEMS, SOME DENTAL CLAIMS THAT APPEARED ON THE REMITTANCE ADVICES BETWEEN THE DATES OF MARCH 30, 2004 AND JUNE 1, 2004 THAT DENIED WITH EOB 103(INVALID TOOTH CODE/ORAL CAVITY DESIGNATOR) MAY HAVE DONE SO IN ERROR. PLEASE REVIEW THESE CLAIMS AND IF THEY WERE SUBMITTED WITH A CORRECT TOOTH NUMBER/LETTER OR ORAL CAVITY DESIGNATOR, PLEASE RESUBMIT FOR REPROCESSING. IF AN INVALID TOOTH NUMBER/LETTER OR ORAL CAVITY DESIGNATOR WAS REPORTED, PLEASE CORRECT THIS INFORMATION AND RESUBMIT THE CLAIM FOR REPROCESSING. ALSO, SOME PROVIDERS ARE STILL FILING CLAIMS USING ORAL CAVITY DESIGNATOR (X,Y, UR, UL, LL, AND LR) WHICH WERE DISCONTINUED EFFECTIVE MAY 1, 2003. PROVIDERS SHOULD BE USING THE ADA ORAL CAVITY DESIGNATORS AS IDENTIFIED IN THE DENTAL SERVICES MANUAL (ISSUE DATE MAY 1, 2003), PAGES 16-15 AND 16-16. SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225)924-5040.

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ATTENTION VISION (EYE WEAR) PROVIDERS

IN THE NEAR FUTURE, MEDICAID WILL AUTOMATICALLY RECYCLE CLAIMS FOR EYE WEAR PROCEDURE CODES THAT BEGIN WITH A "V" WHICH RECEIVED AN 813 (EXACT DUPLICATE) DENIAL ON REMITTANCE ADVICES DATED MARCH 2, 2004 THROUGH  MAY 25, 2004. THIS DENIAL OCCURRED AS A RESULT OF CLAIMS FOR THE SAME  PROCEDURE CODE BEING BILLED ON TWO SEPARATE CLAIM LINES. THIS RECYCLE  WILL OCCUR ONE TIME ONLY; THEREFORE, WHEN BILLING TWO UNITS OF A SINGLE PROCEDURE CODE, PROVIDERS SHOULD REPORT THE TWO UNITS ON A SINGLE CLAIM LINE INDICATING THE CORRECT NUMBER OF UNITS. THE ONLY INSTANCE IN WHICH TWO SEPARATE CLAIM LINES ARE REQUIRED FOR A SINGLE PROCEDURE CODE IS FOR PROCEDURE CODE V2102 WHEN ONE LENS REQUIRES PRIOR AUTHORIZATION AND ONE DOES NOT. IF YOU HAVE ANY QUESTIONS REGARDING THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225)924-5040. 

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ATTENTION ALL DENTAL PROVIDERS

MEDICAID HAS IDENTIFIED A SYSTEM PROBLEM THAT CAUSED THE INCORRECT DENIAL (840-EXACT DUPLICATE) OF DENTAL CLAIMS IN CASES WHERE THE PROVIDER REPORTED BOTH THE TOOTH NUMBER AND THE ORAL CAVITY DESIGNATOR ON THEIR CLAIM. THE SYSTEM PROBLEM HAS BEEN CORRECTED AND MEDICAID WILL AUTOMATICALLY RECYCLE THE CLAIMS INVOLVED. THESE TRANSACTIONS WILL APPEAR ON YOUR REMITTANCE ADVICE IN THE NEAR FUTURE. IF YOU HAVE ANY QUESTIONS RELATED TO THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225)924-5040.