RA Messages for August 8, 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 PROFESSIONAL PROVIDERS

EFFECTIVE WITH DATE OF SERVICE 07/01/00, ANESTHESIA FOR CPT CODE 92960, ELECTRICAL CARDIOVERSION, HAS BEEN FUNDED WITH AN ANESTHESIA BASE UNIT OF 04.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

THE CPT CODES WHICH WERE DISCONTINUED IN THE YEAR 2000 ISSUANCE OF THE CURRENT PROCEDURAL TERMINOLOGY WILL BE PLACED IN NON-PAY STATUS ON OUR FILES EFFECTIVE WITH DATE OF SERVICE AUGUST 15, 2000.  PLEASE PROGRAM YOUR SYSTEMS ACCORDINGLY.

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.

SPECIAL RA MESSAGE

DATE:        AUGUST 9, 2000

TO:            MEDICAID PROVIDERS

FROM:      BEN BEARDEN

THE ATTACHED RA REPRESENTS CLAIMS PAID IN FULL FILE PRICE OR PER DIEM AND NOW HAVE BEEN RECYCLED AND REDUCED TO THE ACTUAL PAYMENT AMOUNT ANNOUNCED IN OUR EMERGENCY RULES PUBLISHED WHEN OUR SPENDING REDUCTION PAN WAS ANNOUNCED IN FEBRUARY.

THIS RA ESTABLISHES YOUR LIABILITY CALCULATED TO DATE AND REPRESENTS ALL OF THE CLAIMS ADJUSTED DURING THE RECOUPMENT PERIOD AS OF THIS RECYCLE.

THE PRODUCTION OF THIS RA WILL NOT INTERFERE WITH OUR NORMAL PRODUCTION CYCLE.

- THE CLAIMS RECYCLED ARE THOSE WITH DATES OF SERVICE BETWEEN FEBRUARY 2000 AND AUGUST 2000.
- THE DIFFERENCE BETWEEN THE ORIGINAL PRICE PAID AND THE REDUCTION ANNOUNCED BY OUR RULE IS NOW BEING IDENTIFIED AND COLLECTED.
- OUR GOAL IS TO COLLECT ALL MONIES BY THE END OF DECEMBER 2000.
- DUE TO THE VOLUME OF CLAIMS TO BE RECYCLED, LIABILITIES WILL BE ESTABLISHED BY PROVIDER TYPE.
- CLAIMS WILL BE RECYCLED UNTIL ALL PROVIDERS RECEIVE NOTICE OF THEIR LIABILITY.
- THIS LIABILITY WILL BE IN ADDITION TO ANY EXISTING NEGATIVE BALANCE A PROVIDER MAY HAVE.
- PROVIDERS SHOULD PAY CLOSE ATTENTION TO THE SPECIFIC EXPLANATION OF BENEFITS (EOB) APPLIES TO EACH CLAIM FOR CLARIFICATION OF THE PAYMENT SCHEDULE.
- WITH EOB #571, 572, AND 573, THE TERM 'OFFSET' IS DEFINED AS "A SMALL ADJUSTMENT TO THE LIABILITY OF THE CLAIM IN THE PROVIDER'S FAVOR AS A RESULT OF ADDITIONAL FUNDS ALLOCATED BY THE LEGISLATURE."

THE DEPARTMENT'S LIABILITY REDUCTION PLAN WILL BE AS FOLLOWS:

1.  NURSING FACILITIES WILL HAVE 20% OF THEIR NEGATIVE BALANCE COLLECTED EACH MONTH.

2. PHARMACY PROVIDERS WILL HAVE 10% OF THEIR NEGATIVE BALANCE COLLECTED FROM EACH CHECK.

3. ALL OTHER PROVIDERS WILL HAVE 30% OF THEIR CHECK APPLIED TO THEIR NEGATIVE BALANCE.

WE HOPE THIS DETAILED REMITTANCE ADVICE WILL ASSIST YOU IN RECONCILING YOUR RECORDS.

QUESTIONS REGARDING THIS RA SHOULD BE ADDRESSED TO UNISYS PROVIDER RELATIONS BY CALLING 1-800-473-2783.