RA Messages for August 23, 2005

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SCHEDULE II NARCOTIC ANALGESICS

PREVIOUSLY, PRESCRIPTIONS FOR SCHEDULE II NARCOTIC ANALGESICS HAD TO BE FILLED WITHIN 5 DAYS OF THE DATE OF THE PRESCRIPTION. THIS POLICY, HOWEVER, HAS BEEN REVISED, EFFECTIVE WITH DATE OF SERVICE AUGUST 20,2005.  THE NEW POLICY STATES THAT PRESCRIPTIONS FOR SCHEDULE II NARCOTIC ANALGESICS SHALL BE FILLED WITHIN 6 MONTHS OF THE DAY THE PRESCRIPTION WAS WRITTEN. A DENIAL ERROR CODE OF #454 (NEW PRESCRIPTION NOT FILLED WITHIN 6 MONTHS OF THE DATE PRESCRIBED), WHICH IS CROSS-REFERENCED TO NCPDP CODE M4, WILL APPLY TO THOSE PRESCRIPTIONS FILLED AFTER 6 MONTHS FROM THE DATE WRITTEN.

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ATTENTION ALL COMMUNITYCARE PROVIDERS

COMMUNITYCARE PROVIDERS WHO PREVIOUSLY RECEIVED COMMUNITYCARE PROVIDER UTILIZATION REPORTS WILL NO LONGER RECEIVE THEM, EFFECTIVE WITH THE APRIL 2005 REPORT. THE DEPARTMENT OF HEALTH AND HOSPITALS (DHH) HAS TEMPORARILY CEASED DISTRIBUTION OF THESE REPORTS. DHH WILL BE WORKING WITH UNISYS TO DEVELOP A NEW, MORE ACCURATE REPORT. QUESTIONS REGARDING THIS ISSUE MAY BE DIRECTED TO THE COMMUNITYCARE PROGRAM OFFICE AT (225)342-1304. 

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ATTENTION PHYSICIANS

SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC 
IMAGING AGENT THALLOUS CHLORIDE TL 201/MCI 

DELETED CPT CODE 78990 HAS BEEN PLACED IN NON-PAY STATUS EFFECTIVE JUNE 1, 2005. HCPCS CODE A9505 (SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, THALLOUS CHLORIDE TL 201/MCI) HAS BEEN MADE PAYABLE EFFECTIVE JANUARY 1, 2005, AT 80% OF THE REGION 99 MEDICARE ALLOWABLE. CLAIMS FOR THIS IMAGING AGENT MAY NOW BE SUBMITTED ELECTRONICALLY AS AN INVOICE WILL NO LONGER BE REQUIRED. 

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PHYSICIAN ASSISTANT UPDATE

IMPLEMENTATION OF THE PROCESSING OF CLAIMS FOR PHYSICIAN ASSISTANT SERVICES EFFECTIVE WITH DATE OF SERVICE 7/1/2005, HAS BEEN DELAYED. PROVIDERS ARE ASKED TO HOLD CLAIMS FOR THESE SERVICES UNTIL NOTIFIED BY THE DEPARTMENT. IT IS ANTICIPATED THAT THE SYSTEM WILL BE READY TO PROCESS PHYSICIAN ASSISTANT CLAIMS WITHIN THE NEXT SEVERAL WEEKS. PLEASE MONITOR FUTURE RA MESSAGES WHICH WILL INFORM PROVIDERS WHEN THESE CLAIMS MAY BE SUBMITTED. 

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CERTIFIED NURSE PRACTITIONER, CLINICAL NURSE SPECIALIST 
AND CERTIFIED NURSE MIDWIFE UPDATE 

THE EFFECTIVE DATE OF IMPLEMENTATION OF THE CHANGES IN REIMBURSEMENT METHODOLOGY FROM A "LIST" OF BILLABLE SERVICES TO COVERED SERVICES DETERMINED BY LICENSURE AND SCOPE OF PRACTICE HAS BEEN CHANGED FROM JULY 1, 2005, TO DATES OF SERVICE BEGINNING AUGUST 1, 2005. CLAIMS WITH DATES OF SERVICE THROUGH JULY 31, 2005 WILL BE PROCESSED UNDER THE "LIST" METHODOLOGY. PROVIDERS ARE ASKED TO HOLD CLAIMS FOR APRN SERVICES WITH DATES OF SERVICE AUGUST 1, 2005 FORWARD UNTIL NOTIFIED BY THE DEPARTMENT. IT IS ANTICIPATED THAT THE SYSTEM CHANGES WILL BE IN PLACE WITHIN THE NEXT SEVERAL WEEKS. PLEASE MONITOR FUTURE RA MESSAGES WHICH WILL INFORM PROVIDERS WHEN THESE CLAIMS MAY BE SUBMITTED.

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ATTENTION MENTAL HEALTH REHABILITATION PROVIDERS

THREE ISSUES HAVE BEEN IDENTIFIED WHICH HAVE CAUSED ERRONEOUS CLAIM DENIALS SINCE THE IMPLEMENTATION OF NEW PROGRAM POLICY. 1.CERTAIN MHR PROCEDURE CODES WERE INADVERTENTLY LOADED TO BE NON-PAYABLE ON DOS 7/31/05 AND DENIED 299.THE DATE ON THESE CODES HAS BEEN CORRECTED TO MAKE THEM NON-PAYABLE WITH AN EFFECTIVE DOS 8/1/05. 2. PROCEDURE CODE H2015-WHEN BILLED WITH AND WITHOUT A MODIFIER, ONE CLAIM PAID AND THE SECOND CLAIM DENIED AS A DUPLICATE WITH EDIT 813. 3.PROCEDURE CODE H0004 BILLED WITH MODIFIERS HR OR HS DENIED 092. THESE ISSUES HAVE BEEN CORRECTED AND ALL CLAIMS DENIALS INVOLVED WILL BE RECYCLED ON THE 8/23/05 RA.