RA Messages for July 29, 2003

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

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PRESCRIBING PROVIDERS AND PHARMACY PROVIDERS

IN THE RECENT JULY 14, 2003 CORRESPONDENCE MAILED TO ALL PRESCRIBING AND PHARMACY PROVIDERS, A PDL LIST "03-04" WAS INCLUDED. THE "03-04" LIST INCLUDES CHANGES THAT WERE MADE TO THE PDL AT THE MAY 21, 2003 P&TEETING. A CURRENT PDL LIST IS AVAILABLE ON THE LAMEDICAID.COM WEBSITE.  

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ATTENTION ALL POS PHARMACY PROVIDERS

CLAIMS PROCESSING ERRORS OCCURRED ON THE 07/22/2003 REMITTANCE ADVICE  (RA).  1)  REVERSALS ON THE 07/15/2003 RA WERE INCORRECTLY REAPPLIED ON THE 07/22/2003 RA.  2)  REVERSALS FROM THE 07/22/2003 WEEKLY CLAIMS PROCESSING CYCLE DID NOT APPEAR ON THE 07/22/2003 RA.  THESE ERRORS HAVE BEEN CORRECTED ON THE 07/29/2003 RA.  NO ACTION IS REQUIRED ON THE PART OF THE PROVIDER.  WE APOLOGIZE FOR ANY INCONVENIENCE THIS MAY HAVE CAUSED.

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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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NOTICE TO CNPS AND CNSS

EFFECTIVE WITH THE DATE OF SERVICE MAY 1, 2003, THE FOLLOWING CPT CODES 
WERE ADDED TO THE LIST OF CODES PAYABLE TO CNPS AND CNSS. 

82270, 82947, 86580, 20610, 76810.

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NOTICE TO ALL PROVIDERS

THE DEPARTMENT OF HEALTH AND HOSPITALS IS INFORMING MEDICAID PROVIDERS REGARDING A STATEWIDE IMMUNIZATION EFFORT BY THE OFFICE OF PUBLIC HEALTH BEGINNING JULY 31 THROUGH AUGUST 2 IN COMMUNITY HEALTH CLINICS. CHILDREN ARE THE PRIMARY FOCUS OF THE EFFORT, WITH ONE GOAL BEING TO SIGNIFICANTLY IMPROVE IMMUNIZATION RATES IN THE 0-24 MONTH AGE GROUP. THIS EFFORT WILL ALSO ASSIST THE STATE AND LOCAL HEALTH OFFICIALS TEST EACH REGION'S  ABILITY TO MASS VACCINATE LARGE NUMBERS OF PEOPLE. WE ARE ENCOURAGING ALL PROVIDERS TO COOPERATE IN THIS EFFORT. 

USING THE LINKS SYSTEM, OPH WILL IDENTIFY AND SEND REMINDERS TO CHILDREN THROUGHOUT THE STATE WHO ARE NOT CURRENT WITH THEIR IMMUNIZATIONS.  PARENTS WILL BE ENCOURAGED TO TAKE THEIR CHILDREN TO THEIR PRIMARY CARE PROVIDER TO HAVE VACCINATIONS BROUGHT UP TO DATE. THIS MAY CAUSE AN INCREASE IN REQUESTS TO MEDICAID PROVIDERS REGARDING IMMUNIZATIONS. ALTERNATIVELY, THEY MAY CHOOSE TO GO TO THE NEAREST PARISH HEALTH UNIT BETWEEN JULY 31 AND AUGUST 2 WITHOUT AN APPOINTMENT. 

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DISCONTINUATION OF STATE ASSIGNED REHABILITATION
THERAPY EVALUATION CODES 

PLEASE DISREGARD EARLIER NOTICES REGARDING THE DISCONTINUATION OF THE 
WHEELCHAIR SEATING EVALUATION PROCEDURE CODE EFFECTIVE SEPT. 1, 2003,AND INSTEAD FOLLOW THE PROCEDURES PER THIS NOTICE. 
EFFECTIVE OCT. 1, 2003, STATE ASSIGNED PROCEDURE CODES Y7702 WHICH IS USED TO BILL FOR THE PHYSICAL THERAPY EVALUATION, STATE ASSIGNED PROCEDURE CODE Y7712 WHICH IS USED TO BILL FOR THE OCCUPATIONAL THERAPY EVALUATION, AND STATE ASSIGNED PROCEDURE CODE Y7902 WHICH IS USED TO BILL FOR THE WHEELCHAIR SEATING EVALUATION, WILL NO LONGER BE PAYABLE. THE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EVALUATION CODES WILL BE REPLACED WITH HIPAA COMPLIANT PROCEDURE CODES 97001 AND 97003, RESPECTIVELY. THE WHEELCHAIR SEATING EVALUATION WILL BE BILLABLE USING MODIFIER UD WITH PROCEDURE CODE 97001 OR 97003, DEPENDING ON WHETHER THE PHYSICAL THERAPIST OR OCCUPATIONAL THERAPIST PERFORMED THE EVALUATION. REIMBURSEMENT RATES WILL BE AT THE ESTABLISHED RATES FOR THE OCCUPATIONAL AND PHYSICAL THERAPY EVALUATION CODES. ONE OCCUPATIONAL THERAPY EVALUATION, ONE PHYSICAL THERAPY EVALUATION, AND ONE WHEELCHAIR SEATING EVALUATION FOR A RECIPIENT OVER A PERIOD OF SIX MONTHS WILL BE ALLOWED, WHEN MEDICALLY NECESSARY.