RA Messages for June 3, 2003

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

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PHARMACY PROVIDERS

EFFECTIVE MAY 30, 2003, DENY CLAIM FACSIMILES WILL NO LONGER BE GENERATED AND MAILED WITH THE RA TO PHARMACY PROVIDERS FOR THE FOLLOWING POS DENY EDIT CODES:

485 - PA REQUIRED
486 - RA EXPIRED
498 - NO OF RX GREATER THAN LIMIT
575 - MISSING OR INVALID ICD-9 CODE
576 - MISSING OR INVALID PA/MC CODE

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HIPAA ALERT

HIPAA IMPLEMENTATION IS LESS THAN 6 MONTHS AWAY!

IF YOU PLAN TO SUBMIT CLAIMS ELECTRONICALLY, YOU MUST REQUIRE YOUR SOFTWARE VENDOR, BILLING AGENT, OR CLEARINGHOUSE (VBC) TO ENROLL IN UNISYS' TESTING PROGRAM. VBC REQUEST ENROLLMENT BY SENDING AN EMAIL TO *HIPAAEDI@UNISYS.COM (NOTE: * IS PART OF THE EMAIL ADDRESS) OR BY CALLING 225-237-3318.

UNISYS PRODUCES A WEEKLY STATUS LIST OF ALL SOFTWARE VENDORS, BILLING AGENTS, AND CLEARINGHOUSES (VBC) THAT ARE PURSUING HIPAA READINESS WITH LA MEDICAID.  TO SUBSCRIBE TO THE VBC LIST, PLEASE SEND AN EMAIL TO *HIPAAEDI@UNISYS.COM (NOTE: * IS PART OF THE EMAIL ADDRESS) AND PUT "SUBSCRIBE TO VBC LIST" IN THE SUBJECT LINE.

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ATTENTION ALL PROVIDERS OF DURABLE MEDICAL EQUIPMENT (DME)

EFFECTIVE MAY 1, 2003, REIMBURSEMENT FOR A NEBULIZER WITH COMPRESSOR HAS
BEEN REDUCED FROM A MAXIMUM OF $95.00 TO A MAXIMUM OF $60.00, NOT TO 
EXCEED THE PROVIDER'S USUAL AND CUSTOMARY CHARGES. THIS REDUCTION WAS 
PUBLISHED AS A RULE IN THE APRIL 20, 2003 EDITION OF THE LOUISIANA 
REGISTER.

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ATTENTION ALL HEMODIALYSIS PROVIDERS

PLEASE BE REMINDED THAT EFFECTIVE WITH CLAIM DATES OF SERVICE MAY 1,2003
PROCEDURE CODES Z6138(CALCITRIOL,2MCG)AND J0635(CALCIJEX {CALCITRIOL}) ARE NO LONGER PAYABLE. THE CORRECT CODE TO BILL FOR THIS SERVICE IS J0636 (CALCITRIOL.1MCG). THIS PROCEDURE CODE CROSSWALK WAS NOT CORRECTLY INDICATED IN THE TRAINING PACKETS DISTRIBUTED AT THE RECENT 2003  PROVIDER TRAINING WORKSHOPS. ALSO NOT MENTIONED IN THE TRAINING PACKET - LOCAL PROCEDURE CODE J0960 (DELATESTRYL INJECTION) SHOULD BE CROSSWALKED
TO CODE J3120 (TESTOSTERONE ENANTHATE INJECTION - UP TO 100 MG). 

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH THE DATE OF SERVICE MAY 1, 2003, CPT CODE 90742(INJECTION
RHOGAM) WILL BE REPLACED CPT CODE J2790 (RHOGAM INJECTION, RHO D IMMUNE 
GLOBULE). CPT CODE 90742 WILL BE PLACED IN NON PAY STATUS EFFECTIVE WITH
DATE OF SERVICE MAY 1, 2003. 

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ATTENTION HOME AND COMMUNITY-BASED WAIVER SERVICES PROVIDERS

FOR INFORMATION ABOUT HOME AND COMMUNITY-BASED WAIVER SERVICES AS AN 
ALTERNATIVE LONG TERM CARE OPTION, PLEASE CALL 1-800-660-0488.

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DISCONTINUATION OF WHEELCHAIR SEATING EVALUATION CODE

EFFECTIVE SEPTEMBER 1, 2003, PROCEDURE CODE Y7902 FOR WHEELCHAIR SEATING EVALUATION WILL BE PUT IN NON-PAY STATUS. PROVIDERS OF THIS SERVICE MUST USE PROCEDURE CODE Y7702 IS A PHYSICAL THERAPIST DOES THE EVALUATION, AND PROCEDURE CODE Y7812 IF AN OCCUPATIONAL THERAPIST DOES THE EVALUATION. THE PHYSICAL THERAPY EVALUATION  IS REIMBURSED AT THE RATE OF $54.00 AND THE OCCUPATIONAL THERAPY EVALUATION IS REIMBURSED AT THE RATE OF $51.00.  WHEN BILLING FOR THESE SERVICES, PROVIDERS MUST SUBMIT A PRESCRIPTION FROM A PHYSICIAN IN ORDER TO RECEIVE REIMBURSEMENT.