RA Messages for August 20, 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 MAKE THE FOLLOWING CHANGES TO THE 1/01/02 VERSION OF APPENDIX B:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

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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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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, 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.

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ATTENTION ALL EPSDT DENTAL PROGRAM PROVIDERS

A REIMBURSEMENT RATE INCREASE FOR CERTAIN DESIGNATED DENTAL PROCEDURE CODES REIMBURSED UNDER THE EPSDT DENTAL PROGRAM WILL BECOME EFFECTIVE JULY 6, 2002 UPON THE APPROVAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS). ADDITIONAL INFORMATION, INCLUDING THE NEW RATES, WILL BE SENT TO YOU ONCE APPROVAL IS GRANTED. 

CLAIMS SUBMITTED FOR PAYMENT PRIOR TO CMS APPROVAL WILL CONTINUE TO BE REIMBURSED AT THE CURRENT REIMBURSEMENT RATE (REFER TO FEE SCHEDULE DATED JANUARY 21, 2001) OR THE AMOUNT BILLED IF LOWER THAN THE ESTABLISHED FEE. 

AFTER APPROVAL BY CMS, CLAIMS SUBMITTED FOR PAYMENT FOR DATES OF SERVICE BEGINNING JULY 6, 2002, UNTIL THE DATE OF PROVIDER NOTIFICATION OF THE NEW RATES, WILL BE AUTOMATICALLY RECYCLED BY MEDICAID. UPON RECYCLING, THE REIMBURSEMENT RATE WILL BE DETERMINED BY THE LESSER OF THE MEDICAID-ESTABLISHED FEE (THE RATE EFFECTIVE JULY 6, 2002) OR THE BILLED CHARGE. AS INSTRUCTED IN THE MEDICAID DENTAL SERVICES MANUAL, YOU SHOULD ALWAYS BILL YOUR USUAL AND CUSTOMARY FEE. ANY ADDITIONAL CLAIM ADJUSTMENTS REQUIRED AFTER THE INITIAL CLAIM RECYCLING WILL BE THE RESPONSIBILITY OF THE PROVIDER. 

REIMBURSEMENT FOR THESE SERVICES IS A FLAT FEE ESTABLISHED BY THE BUREAU MINUS THE AMOUNT THAT ANY THIRD PARTY COVERAGE WOULD PAY.  SHOULD YOU HAVE ANY QUESTIONS, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING 1-800-473-2783.