RA Messages for July 8, 2003

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

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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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ATTENTION ALL MENTAL HEALTH REHAB PROVIDERS

THIS IS A REMINDER THAT IT IS AGAINST POLICY TO SOLICIT RECIPIENTS INTO ENROLLING WITH YOUR AGENCY.

PLEASE REFER TO SECTION 12-5, SECTION A, ITEM 4 OF THE JULY 1, 1999 ISSUE OF THE MENTAL HEALTH REHABILITATION MANUAL WHICH STATES THAT THE SOLICITATION OR SUBSIDIZATION OF ANYONE BY PAYING OR PRESENTING ANY PERSON MONEY OR ANYTHING OF VALUE FOR THE PURPOSE OF SECURING PATIENTS MAY CONSTITUTE SUFFICIENT GROUNDS FOR A PROVIDER ABUSE OR OTHER INCORRECT PRACTICES REFERRAL.

ANY SUSPICION OF THIS KIND OF ACTIVITY WILL BE REPORTED IMMEDIATELY TO THE DEPARTMENT'S PROGRAM INTEGRITY.

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TWO DIGIT PLACE OF SERVICE CODES REQUIRED

AS HIPAA IMPLEMENTATION CONTINUED AND WE WORK TOWARD THE REQUIRED STANDARDIZATION OF CODE SETS, IT IS NECESSARY TO REQUIRE PROVIDERS WHO REPORT PLACE OF SERVICE CODES TO BEGIN USING TWO-DIGIT CODES WHEN COMPLETING CLAIM FORMS. THE OLD ONE-DIGIT PLACE OF SERVICE CODES DO NOT MEET HIPAA REQUIREMENTS AND MAY NO LONGER BE USED WHEN BILLING MEDICAID EFFECTIVE OCTOBER 16, 2003. PLEASE MAKE IMMEDIATE PLANS TO HAVE ANY BILLING SOFTWARE USING THE ONE-DIGIT CODES CONVERT TO THE TWO-DIGIT CODE SET. 

REHABILITATION CENTERS WILL CONTINUE TO BILL THE APPROPRIATE ONE-DIGIT CODES CURRENTLY ACCEPTED ON HARDCOPY FORMS UNTIL FURTHER NOTICE. ALL PROVIDERS THAT ELECT TO BEGIN USING THE HIPAA 837 PROFESSIONAL FORMAT EFFECTIVE JULY 7, 2003 ARE REQUIRED TO USE THE HIPAA STANDARD TWO-DIGIT PLACE OF SERVICE CODES. SHOULD YOU HAVE QUESTIONS CONCERNING THIS TRANSITION, PLEASE CONTACT UNISYS PROVIDER RELATIONS AT 800-473-2783 OR 225-924-5040. 

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ATTENTION PROFESSIONAL SERVICES PROVIDERS

EFFECTIVE JULY 1, 2003, A CHANGE HAS BEEN MADE TO THE EMC PROFESSIONAL SPECIFICATION TO ALLOW BILLING AN EMERGENCY INDICATOR ON EMC CLAIMS WHEN HIGH LEVEL EMERGENCY ROOM SERVICES ARE RENDERED TO COMMUNITYCARE  RECIPIENTS. IF YOU NEED THIS INDICATOR FOR YOUR CLAIMS AND YOU PLAN TO CONTINUE USING THE UNISYS PROPRIETARY SPECS TO BILL EMC CLAIMS UNTIL TRANSITION TO THE HIPAA STANDARDIZED 837P IS REQUIRED, YOUR VENDOR SHOULD CALL THE UNISYS EMC COORDINATOR AT 225-237-3239 TO OBTAIN A COPY 
OF THE REVISED PROPRIETARY SPECS. 

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ATTENTION DENTAL PROVIDERS

WHEN SUBMITTING CLAIMS ON THE 2002 ADA CLAIM FORM, IT IS REQUIRED THAT THE EPSDT INDICATOR IN BLOCK 1 ON THE HARD COPY CLAIM BE MARKED IF THE CLAIM IS FOR AN EPSDT RECIPIENT (UNDER 21 YEARS OLD). IF THIS BLOCK IS NOT MARKED, THE CLAIM IS AUTOMATICALLY PROCESSED AS AN ADULT CLAIM. PLEASE ENSURE THAT YOU ARE MARKING THIS BLOCK WHEN APPROPRIATE AS PROVIDERS ARE CURRENTLY EXPERIENCING MANY CLAIM DENIALS BECAUSE THE BLOCK IS NOT MARKED CORRECTLY. 

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ATTENTION PHYSICIAN PROVIDERS

WITH HIPAA IMPLEMENTATION AND THE MANDATED ELIMINATION OF LOCAL CODES, EFFECTIVE OCTOBER 16, 2003, THE "Y" INDICATOR ENTERED IN FIELD 19 OF THE CMS (HCFA) 1500 CLAIM FORM AND RECORD TYPE E OF THE UNISYS EMC PROPRIETARY SPECS WILL NO LONGER BE ACCEPTED TO INDICATE PROFESSIONAL SERVICES PROVIDED AT A STATE OPERATED (CHARITY) HOSPITAL. ADDITIONALLY, IT HAS BECOME APPARENT THAT SOME PROVIDERS ARE USING THIS INDICATOR FOR SERVICES THAT ARE NOT PROVIDED AT CHARITY HOSPITALS. INAPPROPRIATE USE OF THIS INDICATOR IS UNACCEPTABLE, WILL BE MONITORED, AND CAN RESULT IN PAYMENT RECOUPMENTS. IF PROVIDERS ARE USING THIS INDICATOR AND ARE NOT PROVIDING SERVICES AT A CHARITY HOSPITAL, THEY SHOULD DISCONTINUE THIS PRACTICE IMMEDIATELY.