RA Messages for August 15, 2000

PHARMACY PROVIDERS, PLEASE NOTE!!!

IN A PROVIDER LETTER DATED JULY 19,2000, WE SUBMITTED CHANGES TO THE  FEDERAL UPPER LIMITS (FUL) WHICH WERE TO BECOME EFFECTIVE FOR DATES OF SERVICE BEGINNING AUGUST 1, 2000. WE HAVE BEEN NOTIFIED BY THE HEALTH CARE FINANCE ADMINISTRATION TO DELAY IMPLEMENTATION OF THE AUGUST 1 FEDERAL UPPER LIMITS. THEREFORE, THE GENERIC DESCRIPTIONS WITH THE AUGUST 1 PRICES WILL NOT BE IMPLEMENTED UNTIL THE DEPARTMENT  IS DIRECTED BY HCFA.

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 MAKE THE FOLLOWING CHANGES TO THE 5/15/00 VERSION OF APPENDIX A:

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

NOTICE TO ALL DENTAL PROVIDERS

PERSONS UNDER 21 YEARS OF AGE WHO ARE CERTIFIED FOR MEDICAID UNDER THE MEDICALLY NEEDY PROGRAM ARE NOW ENTITLED TO RECEIVE MEDICAID COVERED EPSDT DENTAL SERVICES.  THE MEDICALLY NEEDY RECIPIENT WILL HAVE A MEDICAID CARD AND THE PROVIDER SHOULD FOLLOW CURRENT  POLICIES AND PROCEDURES, AS STATED IN THE MEDICAID DENTAL SERVICES MANUAL, WHEN PROVIDING SERVICES TO THESE RECIPIENTS.  PROVIDERS SHOULD VERIFY THE RECIPIENT'S ELIGIBILITY USING THE RECIPIENT VERIFICATION SYSTEM (REVS) OR THE MEDICAID ELIGIBILITY VERIFICATION SYSTEM (MEVS).  FOR MORE INFORMATION REGARDING THE MEDICALLY NEEDY PROGRAM, PLEASE REFER TO YOUR DENTAL SERVICES MANUAL, PAGES 1-7 THROUGH 1-8.  SHOULD YOU HAVE ANY FURTHER QUESTIONS REGARDING THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING 1-800-473-2783.

NOTICE TO HOSPITALS

WE HAVE RECENTLY RECEIVED A REQUEST FOR CLARIFICATION OF DISCHARGE TIME.

LOUISIANA MEDICAID ADOPTS MEDICARE'S DEFINITION OF DISCHARGE TIME WHICH IS AS FOLLOWS. 

A HOSPITAL INPATIENT IS CONSIDERED DISCHARGED FROM A HOSPITAL PAID UNDER THE PROSPECTIVE PAYMENT SYSTEM WHEN (1) THE PATIENT IS FORMALLY RELEASED FROM THE HOSPITAL; OR (2)THE PATIENT DIES IN THE HOSPITAL. 

THE ABOVE DEFINITION APPLIES TO BOTH INPATIENT AND OUTPATIENT DISHCARGES

NON-MEDICALLY NECESSARY CIRCUMSTANCES DO NOT FACTOR IN DETERMINING THE  DISCHARGE TIME, AND LOUISIANA MEDICAID WILL NOT REIMBURSE PROVIDERS UNDER THESE CIRCUMSTANCES (EX: PATIENT DOES NOT HAVE A RIDE HOME; PATIENT DOES NOT WANT TO LEAVE THE FACILITY; ETC.). 

IF AND WHEN NON-MEDICALLY NECESSARY CIRCUMSTANCES ARISE AND A RECIPIENT DOES NOT LEAVE THE HOSPITAL WHEN HE IS DISCHARGED, THE HOSPITAL MAY BILL THE RECIPIENT FOR THESE CHANGES, BUT ONLY AFTER HOSPITAL PERSONNEL INFORM THE PATIENT THAT LOUISIANA MEDICAID WILL NOT COVER THIS PORTION OF THE STAY.