RA Messages for July 10, 2007
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.
PLEASE FILE ADJUSTMENTS FOR CLAIMS THAT MAY HAVE BEEN INCORRECTLY
PAID. ONLY THOSE PRODUCTS OF THE MANUFACTURERS WHICH PARTICIPATE IN THE FEDERAL
REBATE PROGRAM WILL BE COVERED BY THE MEDICAID PROGRAM. PARTICIPATION MAY BE
VERIFIED IN APPENDIX C, AVAILABLE AT
WWW.LAMEDICAID.COM
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.
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.
ATTENTION PROVIDERS
LA MEDICAID WILL NOT BE ACCEPTING THE
NEW UB04 FORM ON JULY 2, 2007 AS ANTICIPATED. PROVIDERS SHOULD NOT BEGIN
SUBMITTING UB04 FORMS FOR HARD COPY CLAIMS UNTIL FURTHER NOTICE. ANY
CLAIMS SUBMITTED ON THE UB04 FORM PRIOR TO THE ACCEPTANCE DATE WILL BE
REJECTED WHICH DELAYS PROCESSING AND PAYMENT OF CLAIMS. PLEASE WATCH THE
LA MEDICAID WEBSITE AND RA MESSAGES FOR UPDATED INFORMATION.
ATTENTION DENTAL PROVIDERS
CLAIMS FOR CODES D1110, D1120, D1203
AND D1204 THAT SHOULD HAVE DENIED WITH EOB 234 (P/F AGE RESTRICTION)
WERE PAID IN ERROR BETWEEN THE DATES OF 1/23/07 AND 6/15/07. THESE
PAYMENTS WILL BE AUTOMATICALLY VOIDED BY MEDICAID ON THE RA DATED
6/26/07. IN ADDITION, THE PROGRAMMING REQUIREMENTS FOR CODES D0145,
D1206 AND D1555 ARE NOW COMPLETE AND THE CLAIMS THAT HAVE BEEN
PREVIOUSLY PROCESSED AND DENIED BY MEDICAID FOR THESE CODES WILL BE
AUTOMATICALLY RECYCLED FOR PAYMENT AND WILL ALSO APPEAR ON THE RA DATED
6/26/07.
ATTENTION ALL 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.
ATTENTION DENTAL PROVIDERS
POLICY REMINDER: PER THE 2003 DENTAL
SERVICES MANUAL, PROCEDURE CODE D2930 REQUIRES PRIOR AUTHORIZATION FOR
TOOTH LETTERS B, I, L AND S FOR RECIPIENTS 8 YEARS OF AGE AND OLDER; AND
FOR TOOTH LETTERS A, C, H, J, K, M, R AND T FOR RECIPIENTS 9 YEARS OF
AGE AND OLDER. MEDICAID HAS IDENTIFIED THAT CLAIMS FOR PROCEDURE CODE
D2930 FOR THESE TOOTH LETTERS FOR 8 AND 9 YEAR OLD AND OLDER RECIPIENTS
WERE INCORRECTLY PAID WITHOUT A PRIOR AUTHORIZATION. PROVIDERS ARE
REMINDED THAT THEY MUST FOLLOW MEDICAID DENTAL PROGRAM POLICY AND MUST
OBTAIN PRIOR AUTHORIZATION WHEN REQUIRED AND INCLUDE THE PRIOR
AUTHORIZATION NUMBER ON THE CLAIM FOR PAYMENT.
ATTENTION ALL PROVIDERS
BEGINNING MID-TO-LATE JULY, YOU WILL
BEGIN TO SEE NPI(S) POSTED ON THE HARD COPY REMITTANCE ADVICES. THE NPI
FOR THE BILLING PROVIDER WILL ONLY APPEAR IF YOU HAVE REGISTERED YOUR
NPI WITH LA MEDICAID. THE BILLING NPI WILL APPEAR AT THE UPPER LEFT
CORNER OF EACH RA PAGE IMMEDIATELY FOLLOWING THE 7-DIGIT LA MEDICAID
BILLING PROVIDER NUMBER. NPI(S) FOR ATTENDING PROVIDER(S) WILL ONLY
APPEAR ON THE RA IF THE NPI IS ENTERED
IN THE APPROPRIATE FIELD ON THE CLAIM SUBMITTED FOR PROCESSING. IF THE
NPI IS PRESENT ON THE CLAIM IT WILL BE DISPLAYED ON THE RA BY LINE ITEM
IN THE FIELD "PHYS NO," IMMEDIATELY FOLLOWING THE 7-DIGIT MEDICAID ID
NUMBER OF THE ATTENDING PROVIDER. IF YOU FEEL THE
NPI(S) PRESENTED ON THE RA IS NOT CORRECT FOR THE CORRESPONDING LA
MEDICAID PROVIDER NUMBER(S), PLEASE CONTACT THE UNISYS NPI HELP DESK AT
225/216-6400 OR VIA E-MAIL AT LAMEDICAIDNPI@UNISYS.COM