RA Messages for July 25, 2000

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 MAKE THE FOLLOWING CHANGES TO THE 5/15/00 VERSION OF APPENDIX A:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

NOTICE TO HOME HEALTH AGENCIES

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2000, HOME HEALTH EXTENDED CARE SERVICES ARE TO BE BILLED WITH CODE X9902 AT AN HOURLY RATE OF $24.50. THERE WILL BE NO FIRST HOUR PAYMENT THAT IS DIFFERENT FROM THE ADDITIONAL HOURS. THE RATE HAS BEEN ADJUSTED TO COMPENSATE FOR THE COST OF EXTENDED CARE. ALSO, REMEMBER WHEN SERVICES ARE PROVIDED BY A PHYSICAL THERAPIST  ASSISTANT OR AN LPN, THESE SERVICES ARE TO BE IDENTIFIED BY USING THE NEW CODES, WHICH BECAME EFFECTIVE 2-1-00, WHEN REQUESTING PRIOR  AUTHORIZATION AND IN BILLING.  FOR FURTHER BILLING INSTRUCTIONS, PLEASE REFER TO THE PROVIDER NOTICE  DATED 01-24-00. 

NOTICE TO ALL PROVIDERS

THE DEPARTMENT PLANS TO REPROCESS CLAIMS AND REIMPLEMENT THE MEDICAID SPENDING REDUCTION PLAN AS DETAILED IN EMERGENCY RULES PUBLISHED IN FEBRUARY 2000. THE REPROCESSING OF CLAIMS WILL BEGIN WITH THE FIRST CHECKWRITE IN AUGUST FOR ALL CLAIMS PAID FROM 2/1/00 THROUGH 6/30/00. THEREFORE, DHH WILL BEGIN THE PROCESS OF COLLECTING THE DIFFERENCE  BETWEEN THE LOWER RATE STRUCTURE AND THE CURRENT HIGHER REIMBURSEMENT. THE REPROCESSING OF THESE CLAIMS IS NECESSARY DUE TO BUDGET PROBLEMS EARLIER THIS YEAR. DHH TRIES TO IMPOSE A 7% LOWER RATE STRUCTURE BEGINNING IN FEBRUARY AND MARCH. THESE NEW RATES WERE PUT ON HOLD BY A US DISTRICT COURT. BUT, DHH APPEALED THE COURT ACTION. IN MAY, THE 5TH CIRCUIT COURT OF APPEAL RULED IN THE DEPARTMENT'S FAVOR, THUS ALLOWING  DHH TO REIMPOSE THE LOWER RATE. THROUGHOUT THE COURT PROCEEDINGS AND THE MONTH OF JUNE, DHH REIMBURSED PROVIDERS AT THE HIGHER RATE.  IN ADDITION, BEGINNING WITH DATES OF SERVICE 7/1/00, DHH HAS REINSTATED THE RATES IN EFFECT PRIOR TO THE MEDICAID SPENDING REDUCTION PLAN  PUBLISHED IN FEBRUARY. THIS REINSTATEMENT APPLIES ONLY TO THE 7% LOWER  RATE STRUCTURE. 

UPCOMING PROVIDER TRAINING SESSIONS

WATCH FOR AUGUST RS STUFFERS AND THE AUGUST NEWSLETTER FOR SPECIFIC TIMES OF EACH WORKSHOP. FOLLOWING ARE THE DATES OF TRAINING IN EACH CITY: 
BATON ROUGE - SEPTEMBER 12-13 
SLIDELL - SEPTEMBER 14 
ALEXANDRIA - SEPTEMBER 19-21 
HOUMA/THIBODAUX - SEPTEMBER 26 
NEW ORLEANS - SEPTEMBER 27-29 
MONROE - OCTOBER 2-3 
RUSTON - OCTOBER 4 
SHREVEPORT - OCTOBER 5-6 
LAFAYETTE - OCTOBER 17-19 
LAKE CHARLES- OCTOBER 24-25

NOTICE TO ALL OPTICAL SUPPLIERS

EFFECTIVE IMMEDIATELY, PA REQUESTS RELATED TO EYEGLASSES AND/OR CONTACT LENSES WILL BE GIVEN A 3-MONTH AUTHORIZATION PERIOD. THE PROVIDER SHOULD INDICATE THE APPROPRIATE 3-MONTH SPAN IN THE DATES OF SERVICE BLOCKS ON THE REQUEST FOR PA FORM(PA01). THE BEGINNING DATE SHOULD BE THE DATE OF INITIAL CONTACT WITH THE RECIPIENT. UPON APPROVAL, THE PROVIDER SHOULD  DELIVER THE SERVICES AS SOON AS POSSIBLE WITHIN THE AUTHORIZED PERIOD.  IN ORDER FOR A CLAIM TO BE PAID BY MEDICAID FOR SERVICES THAT REQUIRE PA THE REQUEST MUST HAVE BEEN APPROVED AND DATES OF SERVICE MUST FALL BETWEEN THE DATES LISTED ON THE PA DECISION. THE ACTUAL DATE THAT THE SERVICE WAS DELIVERED SHOULD BE USED AS THE DATE OF SERVICE WHEN FILING  A CLAIM FOR PAYMENT. SHOULD THE PA PERIOD EXPIRE BEFORE THE SERVICE IS DELIVERED, THE PROVIDER SHOULD MAKE A COPY OF THE PA LETTER AND WRITE RECON ACROSS THE TOP. A STATEMENT SHOULD ACCOMPANY THIS RECONSIDERATION REQUEST INDICATING THAT YOU ARE ASKING TO HAVE THE AUTHORIZATION DATES CHANGES AND THE REASON WHY THE SERVICE COULD NOT BE DELIVERED WITHIN THE ORIGINAL AUTHORIZATION PERIOD. SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS MATTER, CONTACT UNISYS PROVIDER RELATIONS AT 1-800-473-2783.