RA Messages for August 17, 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 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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ATTENTION PHYSICIAN AND KIDMED PROVIDERS

EFFECTIVE 8/23/04, FOR CLAIM DATES OF SERVICE BEGINNING 10/1/03 FORWARD, CLAIMS SUBMITTED USING PREVENTIVE MEDICINE PROCEDURE CODES 99381-99385 OR 99391-99395 MUST REFLECT THE CORRECT PROCEDURE CODE FOR THE AGE OF THE CHILD. CLAIM EDITS ARE BEING PLACED IN THE CLAIMS PROCESSING LOGIC THAT WILL PREVENT PAYMENT OF THESE PROCEDURE CODES IF THEY ARE NOT APPROPRIATE FOR THE AGE OF THE CHILD. PLEASE MAKE ANY NECESSARY CHANGES TO YOUR INTERNAL SYSTEMS OR PROCEDURES TO ACCOMMODATE THIS PROCESSING CHANGE. QUESTIONS MAY BE DIRECTED TO PROVIDER RELATIONS AT 800-473-2783 OR 225-924-5040. 

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ATTENTION DENTAL PROVIDERS

SOME DENTAL CLAIMS FOR PROCEDURE CODE D8220 (FIXED APPLIANCE THERAPY) INADVERTENTLY DENIED WITH ERROR CODE 103 (INVALID TOOTH CODE/ORAL CAVITY DESIGNATOR). THE PROBLEM THAT CAUSED THIS ERROR TO BE INCORRECTLY REPORTED HAVE BEEN CORRECTED. IN THE NEAR FUTURE, THESE CLAIMS WILL BE AUTOMATICALLY RECYCLED BY MEDICAID AND WILL APPEAR ON YOUR REMITTANCE ADVICE. SHOULD YOU HAVE ANY QUESTIONS, RELATED TO THIS MATTER, YOU MAY CALL UNISYS PROVIDER RELATIONS AT 800-473-2783 OR 225-924-5040. 

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ATTENTION DENTAL PROVIDERS - ADDITIONAL DENTAL POLICY

DENTAL SERVICES SHOULD NOT BE SEPARATED OR PERFORMED ON DIFFERENT DATES OF SERVICE SOLELY TO ENHANCE REIMBURSEMENT. IF NO RESTORATIVE OR OTHER TREATMENT SERVICES ARE NECESSARY, ALL SEALANTS MUST BE PERFORMED IN A SINGLE DATE OF SERVICE. IF RESTORATIVE OR OTHER TREATMENT SERVICES ARE NECESSARY, SEALANTS MAY BE PERFORMED ON THE SAME DATE OF SERVICE AS THE RESTORATIVE OR OTHER TREATMENT SERVICES. UNLESS CONTRAINDICATED, ALL RESTORATIVE AND TREATMENT SERVICES PER QUADRANT MUST BE PERFORMED ON THE SAME DATE OF SERVICE. THIS ALLOWS THE DENTIST TO COMPLETE ALL RESTORATIVE TREATMENT IN THE AREA OF THE MOUTH THAT IS ANESTHETIZED. IN ADDITION, IF THERE IS A SIMPLE RESTORATION REQUIRED IN A SECOND QUADRANT, THE SIMPLE RESTORATIVE PROCEDURE IN THE SECOND QUADRANT MUST ALSO BE PERFORMED AT THE SAME APPOINTMENT. IF THERE ARE CIRCUMSTANCES THAT WOULD NOT ALLOW RESTORATIVE TREATMENT IN THIS MANNER, THE CONTRAINDICATION(S) MUST BE DOCUMENTED IN THE PATIENT'S DENTAL RECORD. A LEAD APRON AND THYROID SHIELD MUST BE USED WHEN TAKING ANY RADIOGRAPHS REIMBURSED BY THE MEDICAID PROGRAM. WHEN TAKING RADIOGRAPHS, THE USE OF A LEAD APRON AND THYROID SHIELD IS GENERALLY ACCEPTED STANDARD OF CARE PRACTICE, AND IS PART OF NORMAL, ROUTINE, RADIOGRAPHIC HYGIENE. SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS INFORMATION, CALL THE DENTAL MEDICAID UNIT AT 504-619-8589.

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ATTENTION DME PROVIDERS

WE WANT TO REMIND ALL DURABLE MEDICAL EQUIPMENT (DME) PROVIDER THAT THE DATE OF SERVICE ON CLAIMS MUST ALWAYS REFLECT THE ACTUAL DATE OF DELIVERY.  IT IS A VIOLATION OF MEDICAID POLICY TO SUBMIT A REQUEST FOR PAYMENT PRIOR TO THE DATE OF DELIVERY OR TO SHOW THE DATE OF SERVICE AS ANY DATE OTHER THAN THE ACTUAL DATE OF DELIVERY.