RA Messages for July 24, 2001

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 WHICH MAY HAVE BEEN INCORRECTLY PAID.

NOTICE TO AMBULANCE PROVIDERS

THE FOLLOWING CODES HAVE BEEN ADDED EFFECTIVE JANUARY 1, 2001.

A0426    ALS, NON-EMERGENCY TRANSPORT
A0427    ALS, EMERGENCY TRANSPORT
A0428    BLS, NON-EMERGENCY TRANSPORT
A0429    BLS, EMERGENCY TRANSPORT
A0430    FIXED WING AIR TRANSPORT
A0434    ROTARY WING AIR TRANSPORT
A0435    FIXED WING AIR MILEAGE
A0436    ROTARY WING AIR MILEAGE

THE FOLLOWING HCPCS CODES HAVE BEEN DELETED EFFECTIVE APRIL 1, 2001:

A0030    AMB., CONVENTIONAL AIR SERVICE, 1 WAY
A0040    AMB., AIR HELICOPTER SERVICE, TRANSPORT
A0360    BASIC NON-ER SEP MILE & SUPP
A0364    FIXED WING AIR TRANSPORT
A0366    ADV NON-ER SERVSEP MILE &SUPP
A0370    ADV ER SPEC SERV SEP MIL &SUPP
A0999    UNLISTED AMBULANCE SERVICE

ALL MEDICARE CROSSOVER CLAIMS DENIED (WITH EFFECTIVE DATE OF SERVICE 01/01/2001 - PRESENT) FOR ERROR CODE 232 "PROCEDURE CODE NOT COVERED BY PROGRAM" WILL BE RECYCLED FOR PAYMENT.

NOTICE TO AMBULANCE PROVIDERS

AS A RESULT OF THE ALLOCATION OF ADDITIONAL FUNDS BY THE LEGISLATURE DURING THE 2001 REGULAR SESSION, THE BUREAU INCREASED THE REIMBURSEMENT FOR CERTAIN DESIGNATED PROCEDURE CODES FOR EMERGENCY AMBULANCE RATES BY 1.4% OF THE CURRENT RATES IN EFFECT AS OF JUNE 30, 2001 AND FOR NON-EMERGENCY AMBULANCE BASE RATES BY 22% OF THE CURRENT RATE IN EFFECT AS OF JUNE 30, 2001.  THE INCREASE WILL TAKE EFFECT WITH DATES OF SERVICE BEGINNING JULY 1, 2001.  CONTACT GAIL WILLIAMS AT (225)342-1417 FOR ADDITIONAL INFORMATION.

2001 TRAINING SESSIONS

PROVIDER TRAINING SESSIONS WILL BE HELD ON THE FOLLOWING DATES: 
BATON ROUGE - SEPT. 11 AND 13 (NOTE THIS IS A TUESDAY AND THURSDAY) 
COVINGTON - SEPT. 14 
HOUMA - SEPT. 19 (WEDNESDAY) 
NEW ORLEANS - SEPT. 20 AND 21 (THURSDAY AND FRIDAY) 
ALEXANDRIA - SEPT. 26 AND 27 (WEDNESDAY AND THURSDAY) 
MONROE - OCT. 1 AND 2 (MONDAY AND TUESDAY) 
BOSSIER CITY - OCT. 8 AND 9 (MONDAY AND TUESDAY) 
LAFAYETTE - OCT. 8 AND 9 (MONDAY AND TUESDAY) 
LAKE CHARLES - OCT. 10 AND 11 (WEDNESDAY AND THURSDAY) 

WATCH FOR A COMPLETE SCHEDULE OF LOCATIONS AND DATES IN THE AUGUST 
EDITION OF THE PROVIDER UPDATE.

NOTICE TO ALL PROVIDERS

THE DEPARTMENT OF HEALTH AND HOSPITALS HAS BEGUN EXPANDING THE COMMUNITYCARE PROGRAM TO INCLUDE ALL PARISHES THROUGHOUT THE STATE. THE FIRST NEW PARISHES TO BE BROUGHT INTO THE PROGRAM WILL BE CALCASIEU(LAKE CHARLES) AND THE HOUMA/THIBODAUX REGION(ASSUMPTION, LAFOURCHE, ST. JAMES, ST.  JOHN THE BAPTIST, ST. MARY, AND TERREBONNE PARISHES). ALL ELIGIBLE RECIPIENTS IN CALCASIEU PARISH WILL BE ENROLLED IN COMMUNITYCARE EFFECTIVE AUGUST 1, 2001. MEDICAID RECIPIENTS IN OTHER PARISHES THROUGHOUT THE STATE WILL BE BROUGHT INTO THE PROGRAM BEGINNING NOVEMBER 2001 THROUGH THE NEXT YEAR. RECIPIENTS WILL BE GIVEN THE OPPORTUNITY TO CHOOSE A DOCTOR FROM THOSE CLINICS AND DOCTORS WHO HAVE ENROLLED AS PRIMARY CARE PHYSICIANS IN THE  COMMUNITYCARE PROGRAM. RECIPIENTS WHO DO NOT CHOOSE A DOCTOR WILL BE ASSIGNED TO A PRIMARY CARE PHYSICIAN. COMMUNITYCARE RECIPIENTS MUST RECEIVE MOST MEDICAL CARE FROM THEIR ASSIGNED COMMUNITYCARE DOCTOR. OTHER DOCTORS OR HEALTH CARE PROVIDERS, SUCH AS HOSPITALS, MUST HAVE A  REFERRAL FROM THE COMMUNITYCARE PCP IN ORDER TO BE PAID BY MEDICAID FOR SERVICES PROVIDED TO A COMMUNITYCARE RECIPIENT.  PROVIDERS WHO ARE ELIGIBLE TO ENROLL IN THE COMMUNITYCARE PROGRAM  INCLUDE PHYSICIANS, PHYSICIAN GROUPS OR CLINICS, RURAL HEALTH CLINICS, AND FEDERALLY QUALIFIED HEALTH CLINICS. ANY PHYSICIAN OR CLINIC WISHING TO HAVE MORE INFORMATION ABOUT THE PROGRAM OR TO BEGIN ENROLLMENT IN THE PROGRAM, SHOULD CONTACT UNISYS PROVIDER RELATIONS AT 800-473-2783.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE APRIL 1, 2001, LOCALLY ASSIGNED CODE Z9921(LUNELL MONTHLY CONTRACEPTIVE INJECTION) WAS MADE PAYABLE AT A FEE OF $21.10.