RA Messages for August 13, 2002

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 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.

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PLEASE MAKE THE FOLLOWING CHANGES TO THE 1/01/02 VERSION OF APPENDIX C:

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

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PRESCRIBING PRACTITIONERS AND PHARMACY PROVIDERS

REGARDING THE JULY 16, 2002 PREFERRED DRUG LIST NOTIFICATION 02-02, THE IMPLEMENTATION DATE FOR THE BONE RESORPTION SUPPRESSION AGENTS WAS OMITTED.  PLEASE NOTE THIS IMPLEMENTATION DATE IS SEPTEMBER 16, 2002.  

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NOTICE TO PROVIDER OF MR/DD WAIVER SERVICES

EFFECTIVE JULY 18, 2002, THE RATE FOR SIL PER DIEM (Z0006) HAS INCREASED TO $34.98 PER DAY WITH A 365 DAY LIMIT.

* PLEASE NOTE THE DATE CORRECTION. PREVIOUS MESSAGE REFERRED TO A JULY 15 EFFECTIVE DATE. THIS WAS AN ERROR. THE CORRECT EFFECTIVE DATE IS JULY 18.  

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NOTICE TO HEMODIALYSIS CENTERS

SERVICES PROVIDED AT HEMODIALYSIS CENTERS ARE NOW EXEMPT FROM THE COMMUNITYCARE REFERRAL PROCESS. HOWEVER, HEMODIALYSIS CENTERS MAY OFTEN 
 PRESCRIBE SUPPLIES OR SERVICES FOR THEIR PATIENTS WHICH ARE NOT EXEMPT  FROM THE COMMUNITYCARE REFERRAL. IN SUCH CASES, THE HEMODIALYSIS CENTER IS RESPONSIBLE FOR CONTACTING THE PATIENT'S COMMUNITYCARE PRIMARY CARE  PROVIDER TO OBTAIN A REFERRAL WHICH MAY BE PASSED ON TO THE PROVIDERS OF OTHER NON-EXEMPT SERVICES. IN ORDER TO SIMPLIFY THIS PROCESS, A REFERRAL MAY BE GIVEN TO THE HEMODIALYSIS CENTER, FOR A PERIOD NOT TO EXCEED ONE  YEAR, TO COVER NON-EXEMPT SERVICES. 
 

PROVIDERS SHOULD BEGIN IMMEDIATELY TO FOLLOW THE ABOVE PROCEDURE. QUESTIONS REGARDING THIS MATTER MAY BE DIRECTED TO UNISYS PROVIDER  RELATIONS AT 1-800-473-2783. 

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NOTICE TO LAB PROVIDERS

LAB CLAIMS WITH DATES OF RECEIPT 1/1/2000 AND LATER, WITH DENIAL CODES 329, 387, AND 475 HAVE BEEN RECYCLED. ALL CLAIMS HAVE BEEN CORRECTLY PAID OR DENIED. IF YOU HAVE ANY QUESTIONS CONTACT UNISYS PROVIDER  RELATIONS AT (225)924-5040 OR (800)473-2783.

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2002 PROVIDER TRAINING SESSIONS

PROVIDER TRAINING SESSIONS WILL BE HELD ON THE FOLLOWING DATES: 

BATON ROUGE - OCTOBER 1,2,3 
COVINGTON - OCTOBER 4 
BOSSIER CITY - OCTOBER 7,8,9 
LAFAYETTE - OCTOBER 14,15,16 
NEW ORLEANS - OCTOBER 21,22,23 
HOUMA - OCTOBER 24 
ALEXANDRIA - NOVEMBER 4,5,6 
LAKE CHARLES - NOVEMBER 7,8 
MONROE - NOVEMBER 12,13,14 

PLEASE REFER TO THE JUNE/JULY EDITION OF THE PROVIDER UPDATE FOR A COMPLETE SCHEDULE OF TRAINING SESSION DATES AND LOCATIONS. 
NOTE: THERE WERE 2 ERRORS IN THE SCHEDULE APPEARING IN THE JUNE/JULY PROVIDER UPDATE. THE SESSION LISTED AS PHARMACY PA SHOULD BE LISTED AS THE PHARMACY PROVIDER WORKSHOP.  ONLY PHARMACY PROVIDERS SHOULD ATTEND. THE LONG TERM CARE SESSION IS FOR ICF/MR FACILITIES ONLY. ADULT DAY PROVIDERS SHOULD NOT ATTEND. 

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NOTICE TO ALL PROVIDERS

EFFECTIVE JULY 1, 2002, EMERGENCY DEPARTMENT PHYSICIAN VISITS OF MODERATE TO HIGH COMPLEXITY (CPT 99283, 99284, AND 99285, 99291,99243, 99244, 99245),AND ASSOCIATED HOSPITAL SERVICES WILL BE EXEMPT FROM THE COMMUNITYCARE POST-AUTHORIZATION PROCESS. 
HOSPITALS BILLING FOR SERVICES ASSOCIATED WITH MODERATE TO HIGH LEVEL EMERGENCY PHYSICIAN CARE, SHOULD PLACE A "3" IN FORM LOCATOR 11 ON THE UB92.MODERATE TO HIGH LEVEL COMPLEXITY SHOULD CORRESPOND TO THE LEVEL OF CARE NOTED IN THE DEFINITION OF EVALUATION AND MANAGEMENT CPT CODES 99283, 99284, 99285.PROVIDERS ARE RESPONSIBLE FOR SUBMITTING ADJUSTMENTS FOR ANY CLAIMS PAID INCORRECTLY.  HOSPITALS BILLING FOR SERVICES ASSOCIATED WITH LOW LEVEL EMERGENCY PHYSICIAN CARE, SHOULD PLACE A "1" IN FORM LOCATOR 11 ON THE UB92. LOW LEVEL COMPLEXITY SHOULD CORRESPOND TO THE LEVEL OF CARE NOTED IN THE DEFINITION OF EVALUATION AND MANAGEMENT CPT CODES 99281, 99282.  WHEN AN ENROLLEE IS HOSPITALIZED OR RECEIVES SERVICES IN THE ER, IT IS THE HOSPITAL'S RESPONSIBILITY TO ENSURE THAT THE PCP'S AUTHORIZATION NUMBER IS AVAILABLE FOR ANY OTHER PROVIDERS THAT WILL BILL MEDICAID FOR SERVICES RELATED TO THE HOSPITAL ADMISSION OR ER VISIT. 

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NOTICE TO ALL PROVIDERS

EFFECTIVE JULY 1, 2002, RECIPIENTS WHO HAVE TPL COVERAGE WHICH INLCUDE PHYSICIAN SERVICES WILL BE EXEMPT FROM THE COMMUNITYCARE PROGRAM. THESE RECIPIENTS WILL NOT BE ENROLLED IN COMMUNITYCARE AND THEREFORE WILL NOT BE LINKED TO A PCP. 

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NOTICE TO ALL PROVIDERS

EFFECTIVE JULY 1, 2002, RECIPIENTS WHO RECEIVE HOSPICE SERVICES WILL BE EXEMPT FROM THE COMMUNITYCARE PROGRAM. THESE RECIPIENTS WILL NOT BE ENROLLED IN COMMUNITYCARE AND THEREFORE WILL NOT BE LINKED TO A PCP.