RA Messages for August 10, 2004

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ATTENTION PHARMACY PROVIDERS:

ACCORDING TO GUIDANCE SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) IN A STATE MEDICAID DIRECTOR'S LETTER DATED JULY 19, 2004, A MEDICAID RECIPIENT WHO HAS A MEDICARE-APPROVED DISCOUNT CARD DOES NOT HAVE TO UTILIZE THE $600 BENEFIT PRIOR TO MEDICAID REIMBURSING FOR A PHARMACY CLAIM. "..... A BENEFICIARY WITH A MEDICARE-APPROVED DRUG DISCOUNT CARD AND TRANSITIONAL ASSISTANCE WHO IS ALSO ELIGIBLE FOR MEDICAID DOES NOT HAVE TO SPEND THE $600 CREDIT BEFORE MEDICAID WILL PAY FOR THE BENEFICIARY'S PRESCRIPTION DRUGS."                                                               

CMS FURTHER STATES IN A DRUG CARD AND MEDICAID SPENDDOWN QS AND AS, "...MEDICAID BECOMES THE PRIMARY PAYOR FOR DRUGS COVERED BY MEDICAID, THE  INDIVIDUAL CAN SAVE WHATEVER REMAINS OF THE $600 CREDIT TO USE IN THE  FUTURE SHOULD HE LOSE MEDICAID BENEFITS (OR USE FOR DRUGS THAT ARE NOT COVERED BY MEDICAID)..."                                          

PLEASE DISREGARD EARLIER DIRECTIONS GIVEN BY LOUISIANA MEDICAID BENEFITS MANAGEMENT UNIT REGARDING UTILIZATION OF THE $600 CREDIT ASSOCIATED WITH THE MEDICARE-APPROVED DISCOUNT CARDS.  

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NOTICE TO PROFESSIONAL SERVICE PROVIDERS

FEES WHICH WERE INCORRECTLY LOADED FOR PROCEDURE CODE G0317, G0318, G0319 AND G0327 HAVE BEEN REVISED. RECYCLE OF PREVIOUSLY DENIED CLAIMS AND ADJUSTMENT OF PREVIOUSLY PAID CLAIMS WILL APPEAR ON FORTHCOMING REMITTANCE ADVICES. 

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NOTICE TO PROFESSIONAL SERVICE PROVIDERS

PROCEDURE CODE 59409 HAS BEEN MADE PAYABLE EFFECTIVE MARCH 1, 2003. PREVIOUSLY DENIED CLAIMS WILL BE RECYCLED BY THE DEPARTMENT AND WILL APPEAR ON A REMITTANCE ADVICE IN THE NEAR FUTURE. THE REIMBURSEMENT FOR THIS CODE WILL BE $697.26. WHEN THIS CODE WAS IMPLEMENTED, THE REIMBURSEMENT FOR CPT CODE 59410 WAS INADVERTENTLY REDUCED TO $697.23. ALL CLAIMS FOR CPT 59410 THAT PAID AT THIS REDUCED RATE WILL BE RECYCLED AND ADJUSTED TO RECEIVE THE CORRECT REIMBURSEMENT OF $774.00 ON A REMITTANCE ADVICE IN THE VERY NEAR FUTURE.

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NOTICE TO DURABLE MEDICAL EQUIPMENT PROVIDERS

IF YOU HAVE RECEIVED A PRIOR AUTHORIZATION ON LOCAL CODES E1005, E1352, OR Z0519 THAT HAS DATES OF SERVICE AFTER THE IMPLEMENTATION OF THE HIPAA CODES (03/01/2004) YOU SHOULD BE BILLING WITH THE HIPAA STANDARD CODE FOR THE DATES OF SERVICE AFTER HIPAA IMPLEMENTATION. FOR LOCAL CODE E1352, WHEN PRIOR AUTHORIZATION WAS RECEIVED FOR THIS LOCAL CODE, ALL CLAIMS FOR DATES OF SERVICE AFTER HIPAA IMPLEMENTATION (03/01/2004) SHOULD BE BILLED USING THE STANDARD CODE A4331. FOR LOCAL CODE Z0519, WHEN THE PRIOR AUTHORIZATION WAS RECEIVED FOR THIS LOCAL CODE, ANY CLAIMS FOR DATES OF SERVICE AFTER HIPAA IMPLEMENTATION (03/01/2004) SHOULD BE BILLED USING STANDARD CODE A4556. FOR LOCAL CODE E1005, WHEN THE PRIOR AUTHORIZATION WAS RECEIVED FOR THIS LOCAL CODE, ANY CLAIMS FOR DATE OF SERVICE AFTER HIPAA IMPLEMENTATION (03/01/2004) SHOULD BE BILLED USING STANDARD CODE E2360. IN THE FUTURE, PRIOR AUTHORIZATION REQUESTS AND BILLING CLAIMS SHOULD BE SENT USING THE STANDARD CODE THAT IS APPLICABLE TO THE SITUATION. 

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REVISED NOTICE TO AUDIOLOGISTS

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2003, THE FOLLOWING CPT CODES WERE ADDED TO THE LIST OF CODES PAYABLE TO AUDIOLOGISTS. 

92541         92542         92543         92544         92545         92547