RA Messages for August 5, 2003

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

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PRESCRIBING PROVIDERS AND PHARMACY PROVIDERS

AEROBID ADN AEROBID M ARE ON THE PREFERRED DRUG LIST (PDL) EFFECTIVE AUGUST 4, 2003. THE PDL LIST AT WWW.LAMEDICAID.COM IS BEING UPDATED TO REFLECT THIS CHANGE. PLEASE UPDATE YOUR HARD COPY OF THE PDL LIST.

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ATTENTION ALL POS PHARMACY PROVIDERS

CLAIMS PROCESSING ERRORS OCCURRED ON THE 07/22/2003 REMITTANCE ADVICE  (RA).  1)  REVERSALS ON THE 07/15/2003 RA WERE INCORRECTLY REAPPLIED ON THE 07/22/2003 RA.  2)  REVERSALS FROM THE 07/22/2003 WEEKLY CLAIMS PROCESSING CYCLE DID NOT APPEAR ON THE 07/22/2003 RA.  THESE ERRORS HAVE BEEN CORRECTED ON THE 07/29/2003 RA.  NO ACTION IS REQUIRED ON THE PART OF THE PROVIDER.  WE APOLOGIZE FOR ANY INCONVENIENCE THIS MAY HAVE CAUSED.

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DISCONTINUATION OF STATE ASSIGNED REHABILITATION
THERAPY EVALUATION CODES 

PLEASE DISREGARD EARLIER NOTICES REGARDING THE DISCONTINUATION OF THE 
WHEELCHAIR SEATING EVALUATION PROCEDURE CODE EFFECTIVE SEPT. 1, 2003,AND INSTEAD FOLLOW THE PROCEDURES PER THIS NOTICE. 
EFFECTIVE OCT. 1, 2003, STATE ASSIGNED PROCEDURE CODES Y7702 WHICH IS USED TO BILL FOR THE PHYSICAL THERAPY EVALUATION, STATE ASSIGNED PROCEDURE CODE Y7712 WHICH IS USED TO BILL FOR THE OCCUPATIONAL THERAPY EVALUATION, AND STATE ASSIGNED PROCEDURE CODE Y7902 WHICH IS USED TO BILL FOR THE WHEELCHAIR SEATING EVALUATION, WILL NO LONGER BE PAYABLE. THE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EVALUATION CODES WILL BE REPLACED WITH HIPAA COMPLIANT PROCEDURE CODES 97001 AND 97003, RESPECTIVELY. THE WHEELCHAIR SEATING EVALUATION WILL BE BILLABLE USING MODIFIER UD WITH PROCEDURE CODE 97001 OR 97003, DEPENDING ON WHETHER THE PHYSICAL THERAPIST OR OCCUPATIONAL THERAPIST PERFORMED THE EVALUATION. REIMBURSEMENT RATES WILL BE AT THE ESTABLISHED RATES FOR THE OCCUPATIONAL AND PHYSICAL THERAPY EVALUATION CODES. ONE OCCUPATIONAL THERAPY EVALUATION, ONE PHYSICAL THERAPY EVALUATION, AND ONE WHEELCHAIR SEATING EVALUATION FOR A RECIPIENT OVER A PERIOD OF SIX MONTHS WILL BE ALLOWED, WHEN MEDICALLY NECESSARY.

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ATTENTION HOME HEALTH PROVIDERS

ALL PROVIDERS ARE RESPONSIBLE FOR FILING THE CORRECT BILLING CODES ON A 
CLAIM. IF A LPN PROVIDED SERVICES, THE PROVIDER MUST SUBMIT THE APPROPRIATE LPN SERVICE CODE FOR PAYMENT. LIKEWISE, IF AN RN DELIVERS THE SERVICE, THE CLAIM MUST IDENTIFY THE CODE ASSOCIATED WITH THE APPROPRIATE SERVICE. HOME HEALTH PROVIDERS SHOULD PERFORM A SELF-AUDIT TO IDENTIFY CLAIMS PAID INCORRECTLY AND REPORT ANY OVERPAYMENTS TO PROGRAM INTEGRITY. ALL PROVIDERS ARE RESPONSIBLE IN ASSURING THAT YOUR PROFESSIONAL EMPLOYEES(EX. RNS, LPNS, AIDES, ETC.) ARE ONLY PRACTICING WITHIN THE LIMITATIONS ESTABLISHED BY THEIR LICENSING BOARDS. 

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ATTENTION ALL DENTAL PROVIDERS

POLICY REVISION - ACRYLIC INTERIM PARTIAL DENTURE MEDICAID MAY PROVIDE AN ACRYLIC INTERIM PARTIAL DENTURE (D5820/D5821) IN THE MIXED DENTITION OR BEYOND THE MIXED DENTITION STAGES IN THE FOLLOWING CASES: 1) MISSING ONE OR TWO MAXILLARY PERMANENT ANTERIOR TOOTH/TEETH; OR 2) MISSING TWO MANDIBULAR PERMANENT ANTERIOR TEETH; OR 3) MISSING THREE OR MORE PERMANENT TEETH IN THE SAME ARCH (OF WHICH AT LEAST ONE MUST BE ANTERIOR). THE DENTAL SERVICES MANUAL WILL BE REVISED TO REFLECT THIS INFORMATION. THIS REVISION WILL BE SENT TO ALL DENTAL PROVIDERS. SHOULD YOU HAVE ANY QUESTIONS, YOU MAY CALL THE LSU DENTAL MEDICAID UNIT AT 504-619-8589. 

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ATTENTION ALL RHC/FQHC PROVIDERS

PLEASE REMEMBER WHEN BILLING THE ENCOUNTER CODE, T1015, FOR KIDMED SCREENINGS ON THE NEW KM-3 FORM AND FOR IMMUNIZATIONS BILLED ON THE HCFA 1500 FORM, MODIFIER EP IS REQUIRED. ALL CLAIMS BILLED USING T1015 PLUS THE EP MODIFIER MUST INCLUDE SUPPORTING DETAIL PROCEDURES. PLEASE REFER TO THE 2003 RHC/FQHC TRAINING PACKET FOR COMPLETE BILLING INSTRUCTIONS. THIS PACKET CAN BE FOUND ON THE WEB SITE, LAMEDICAID.COM. IF YOU HAVE ADDITIONAL QUESTIONS OR DO NOT HAVE WEB ACCESS AND NEED THE 2003 TRAINING PACKET, PLEASE CONTACT PROVIDE RELATIONS AT (800)473-2783 OR (225) 924-5040. 

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ATTENTION ALL PHARMACY PROVIDERS

THE UPGRADE OF THE LOUISIANA POINT OF SALE SYSTEM IS ON SCHEDULE FOR THE WEEKEND OF AUGUST 24, 2003. THIS IMPLEMENTATION WILL REQUIRE PROVIDERS TO CHANGE THEIR SOFTWARE TO SEND CLAIMS IN THE HIPAA-MANDATED 5.1 VERSION OF NCPDP. THE LOUISIANA VENDOR SPECIFICATIONS ARE AVAILABLE ON WWW.LAMEDICAID.COM <HTTP://WWW.LAMEDICAID.COM>. PLEASE MAKE SURE YOUR SOFTWARE VENDOR HAS RECEIVED THE LOUISIANA SPECIFICATIONS FROM YOUR SWITCH VENDOR AND INSTALLED YOUR UPGRADE FOR NCPDP 5.1 PRIOR TO AUGUST 24TH SINCE CLAIMS WILL NOT BE PROCESSED WITH THE NCPDP 3.2 FORMAT AFTER THE CUTOVER ON THAT DATE.