RA Messages for July 20, 2004

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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 

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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NOTICE TO PROVIDER OF PROFESSIONAL SERVICES

CPT CODE 83880 WAS IN NON PAY STATUS AND ERRONEOUSLY LISTED ON OUR FILES AS ASSAY NALORPHINE. CPT CODE 83880 (NATRIURETIC PEPTIDE) HAS BEEN CORRECTED AND PLACED IN PAY STATUS EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2003.

CLAIMS WITH DATED OF SERVICE PAST ONE YEAR SHOULD BE SUBMITTED HARD COPY WITH PROOF OF TIMELY FILING TO UNISYS PROVIDER RELATIONS.

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ATTENTION ALL VISION (EYE WEAR) PROVIDERS

UNDER THE CURRENT BILLING POLICY FOR EYE WEAR SERVICES, THE ONLY ACCEPTABLE MODIFERS ARE "LT" FOR LEFT AND "RT" FOR RIGHT. BILLING INAPPROPRIATE MODIFERS WILL CAUSE THE CLAIM TO DENY. PLEASE MAKE ANY CHANGES NECESSARY IN YOUR BILLING SYSTEM TO ENSURE THAT THE APPROPRIATE MODIFIERS ARE BEING BILLED. THESE MODIFIERS SHOULD ONLY BE USED WHEN BILLING PROCEDURE CODE V2102 WHEN THE STRENGTH IS OVER 12.00 SPHERE. WHEN BILLING PROCEDURE CODE V2102 WHEN THE STRENGTH IS 7.12 TO 12.00 SPHERE, OR ANY OTHER EYE WEAR PROCEDURE CODE, NO MODIFIER SHOULD BE USED. BILLING
WITH MODIFIERS WHEN THEY ARE NOT REQUIRED MAY CAUSE PROBLEMS WITH THE PAYMENT OF YOUR CLAIM. PROVIDERS MUST DOCUMENT WHETHER THE REQUESTED LENS IS FOR THE RIGHT EYE OR THE LEFT EYE IN THE PATIENT'S RECORD. IN ADDITION, WHEN BILLING TWO UNITS OF A SINGLE PROCEDURE CODE, IT SHOULD BE REPORTED ON A SINGLE CLAIM LINE INDICATING THE CORRECT NUMBER OF UNITS; HOWEVER, TWO SEPARATE CLAIM LINES ARE REQUIRED IF 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.