RA Messages for July 3, 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.

KIDMED CLAIMS CUTOFF CHANGE

FOR THE JULY 4TH HOLIDAY, THE ELECTRONIC SUBMISSION CUT-OFF TIME FOR ALL KIDMED CLAIMS WILL BE TUESDAY, JULY 3RD, 4:30 P.M. ALL OTHER EDI CLAIMS SUBMISSIONS WILL HAVE THE CUSTOMARY CUTOFF TIME ON THURSDAY, JULY 5TH, 10:00 A.M.

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.

ADDITIONAL YEAR-END CHECKWRITE

AN ADDITIONAL YEAR-END CHECKWRITE DATED 6/28/07 WILL BE RUN THIS WEEK. ALL PROCESSED CLAIMS AND AUDIT TRANSACTIONS WILL APPEAR ON THIS SPECIAL CHECKWRITE. BECAUSE OF THIS, THE PAYMENT AMOUNT FOR THE 6/26/07 CHECKWRITE WILL BE ON REVS ONLY UNTIL 6/28/07 WHEN IT WILL BE OVERLAYED WITH THE NEW INFORMATION FOR THE 6/28/07 CHECKWRITE. THE PAYMENT AMOUNT FOR 6/28/07 WILL REMAIN ON REVS ONLY UNTIL 7/1/07 WHEN IT WILL BE OVERLAYED
WITH NEW INFORMATION FOR THE REGULAR 7/3/07 CHECKWRITE. PLEASE BE AWARE
THAT A PORTION OF ANY PAYMENTS GENERALLY EXPECTED ON THE 7/3/07 CHECKWRITE MAY APPEAR ON THE 6/28/07 CHECKWRITE, THUS, AFFECTING YOUR PAYMENT FOR 7/3/07. FOR QUESTIONS ABOUT ELECTRONIC RAS, CALL EDI AT 225-216-6000, X2. FOR ALL OTHER QUESTIONS, CALL UNISYS PROVIDER RELATIONS AT (800) 473-2783 OR (225) 924-5040.

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.