RA Messages for September 25, 2001

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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 12/9/00 VERSION OF APPENDIX A:

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PLEASE MAKE THE FOLLOWING CHANGES TO THE 12/9/00 VERSION OF APPENDIX C:

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

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ATTENTION DENTAL PROVIDERS

ESPDT DENTAL PROGRAM AND ADULT DENTURE PROGRAM CLARIFICATION OF REQUIREMENTS FOR IDENTIFICATION INFORMATION PROCESSED INTO NEW REMOVABLE DENTAL PROSTHETICS 

 THE IDENTIFICATION REQUIREMENTS WHICH MUST BE PROCESSED INTO NEW REMOVABLE DENTAL PROSTHETICS FOR BOTH THE EPSDT DENTAL AND ADULT DENTURE PROGRAM HAVE BEEN SHORTENED. EFFECTIVE IMMEDIATELY, THE FOLLOWING  INFORMATION MUST BE PROCESSED INTO THE ACRYLIC BASE OF EACH NEW  REMOVABLE DENTAL PROSTHESIS: THE FIRST FOUR LETTERS OF THE RECIPIENT'S LAST NAME, FIRST INITIAL, MONTH AND YEAR, AND THE LAST FIVE DIGITS OF  THE MEDICAID PROVIDER NUMBER. THE POSSIBLE INCREASE IN EXPENSE  ASSOCIATED WITH THIS REQUIREMENT WAS CALCULATED INTO THE JANUARY 21, 2001 RATE INCREASE. SHOULD YOU HAVE FURTHER QUESTIONS, PLEASE CONTACT THE LSU DENTAL SCHOOL, DENTAL MEDICAID UNIT, BY CALLING 504-619-8589. 

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ATTENTION ALL ADULT DENTURE PROGRAM PROVIDERS

 ADULT DENTURE PROGRAM SERVICE LOCATION POLICY  EFFECTIVE MAY 20, 2001, THE DEPARTMENT OF HEALTH AND HOSPITALS, OFFICE OF THE SECRETARY, BUREAU OF HEALTH SERVICES FINANCING ESTABLISHED  REQUIREMENTS FOR ADULT DENTURE PROGRAM PROVIDERS REIMBURSED UNDER THE  MEDICAID PROGRAM AND CONDUCTING BUSINESS AT LOCATIONS OTHER THAN THEIR PRINCIPLE PLACE OF PRACTICE. ADULT DENTURE PROGRAM PROVIDERS SHALL  PROVIDE THE PHYSICAL ADDRESS AND BUSINESS TELEPHONE NUMBER OF THEIR PRINCIPLE PLACE OF PRACTICE TO THE MEDICAID PROVIDER ENROLLMENT UNIT AND TO THE DHH DENTAL CONSULTANTS AT THE LSU SCHOOL OF DENTISTRY. RECORDS DOCUMENTING THE SERVICES PROVIDED SHALL BE MAINTAINED AT THIS LOCATION. TO BE ELIGIBLE FOR REIMBURSEMENT UNDER THE ADULT DENTURE  PROGRAM, THE SERVICE MUST BE PERFORMED IN EITHER THE PARISH WHERE THE PROVIDER'S PRINCIPLE PLACE OF PRACTICE IS LOCATED, ANY SURROUNDING  PARISH WITH A CONTIGUOUS BORDER OF AT LEAST ONE MILE, OR ANY PARISH  WITH A LAND BORDER OF AT LEAST ONE MILE CONTIGUOUS WITH THOSE PARISHES. SHOULD YOU HAVE ANY FURTHER QUESTIONS REGARDING THIS MATTER, YOU MAY  CONTACT THE LSU SCHOOL OF DENTISTRY, DENTAL MEDICAID UNIT BY CALLING 504-619-8589.

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

PROVIDER, PLEASE BE REMINDED THAT YOU CANNOT ALWAYS BILL THE RECIPIENT FOR A SERVICE ON WHICH YOU'VE RECEIVED A 299 OR 232 DENIAL.

SOME CPT CODES ARE IN A NON-PAYABLE STATUS ON OUR FILES BECAUSE THEIR SERVICES AS DESCRIBED IN CPT ARE INCLUDED ON OTHER CODES WHICH ARE COVERED.

WHEN THE DENIED SERVICE IS NOT PAYABLE ON THE FILE BECAUSE IT IS A COMPONENT OF A PAYABLE SERVICE, IT CANNOT BE BILLED TO THE RECIPIENT.  FOR EXAMPLE, CODE 92015 (DETERMINATION OF REFRACTIVE STATE) CANNOT BE BILLED TO THE RECIPIENT BECAUSE ITS FEE IS INCLUDED IN THE FEE FOR THE OFFICE VISIT.  THEREFORE, CODE 92015 CANNOT BE BILLED TO THE RECIPIENT IF DENIED WITH A 299 OR 232.  ANOTHER SERVICE WHICH CANNOT BE BILLED TO THE RECIPIENT IS THE ADMINISTRATION OF AN INJECTION OF A VACCINE FOR WHICH THE PHYSICIAN HAS TO PAY.  BECAUSE THE FEE FOR ADMINISTRATION OF THE VACCINE IS INCLUDED IN THE FEE FOR THE OFFICE VISIT, THE RECIPIENT CANNOT BE BILLED WHEN THE ADMINISTRATION CODE IS DENIED.