RA Messages for September 9, 2003

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 1/01/02 VERSION OF 
APPENDIX A:

DRUG DOSAGE STRGTH MAC EFF DATE
***HALOPERIDOL TAB TABLET 20MG OFF MAC 08/01/03

ATTN PHARMACY PROVIDERS

WITH THE RECENT IMPLEMENTATION OF NCPDP 5.1 VERSION DUE TO HIPAA REGULATIONS, THERE WERE TECHNICAL ISSUES THAT WERE IDENTIFIED WITH THE   MONTHLY PRESCRIPTION LIMIT EDIT. UNTIL THESE ISSUES WERE RESOLVED, IT WAS NECESSARY TO TURN THE MONTHLY PRESCRIPTION LIMIT EDIT FROM A DENY STATUS TO AN EDUCATIONAL STATUS FOR A SHORT PERIOD OF TIME. THE EDITS ARE AS FOLLOWS:                                                      

575 - MISSING OR INVALID ICD-9 DIAGNOSIS CODE FOR RX OVERRIDE.  
576 - MISSING OR INVALID PA/MC CODE OR NUMBER FOR RX OVERRIDE.
498 - NUMBER OF PRESCRIPTIONS GREATER THAN LIMIT                

WE APPRECIATE YOUR CONTINUED EFFORTS IN WORKING WITH THE MONTHLY PRESCRIPTION LIMIT.                                                     

REMINDER TO ALL HOME HEALTH PROVIDERS

HOME HEALTH AGENCIES ARE NOT TO BILL MEDICAID FOR REHABILITATION IN NURSING HOMES. AS PER THE CODE OF FEDERAL REGULATIONS, SECTION 440.70, "A RECIPIENT'S PLACE OF RESIDENCE, FOR HOME HEALTH SERVICES, DOES NOT INCLUDE A HOSPITAL, NURSING FACILITY, OR INTERMEDICATE CARE FACILITY FOR THE MENTALLY RETARDED." 

ATTENTION RHC/FQHC PROVIDERS

PLEASE REMEMBER WHEN BILLING THE ENCOUNTER CODE,T1015,FOR KIDMED SCREENINGS, MODIFIER EP IS REQUIRED.THIS INCLUDES THE CHARGES ON THE NEW KM3 FORM AND THE CHARGES ON THE HCFA 1500 IF IMMUNIZATIONS ARE INDICATED 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. IF YOU HAVE ADDITIONAL QUESTIONS OR NEED THE 2003 TRAINING PACKET, PLEASE CONTACT PROVIDER RELATIONS AT (800) 473-2783 OR (225) 924-5040. 

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

WE ARE UNBUNDLING THE FEE FOR THE INTRAUTERINE COPPER CONTRACEPTIVE EFFECTIVE WITH DATE OF SERVICE 10/1/03. CURRENTLY,A PORTION OF THE FEE IS FOR INSERTING THE DEVICE, A PORTION IS FOR HANDLING AND SHIPPING AND THE REMAINDER IS FOR THE DEVICE. EFFECTIVE WITH DATE OF SERVICE 10/1/03, CODE J7300 SHALL BE BILLED FOR THE DEVICE ($344.00) AND THE MOST APPROPRIATE CPT CODE SHALL BE BILLED FOR THE INSERTION. NO FEE WILL BE PAID FOR HANDLING AND SHIPPING. 

NOTICE TO ALL KIDMED PROVIDERS

PLEASE BE AWARE THAT REVISED KM-3 FORMS ARE NOW BEING ISSUES FOR BILLING AS SUPPLIES OF YOUR CURRENT KM-3 FORMS ARE DEPLETED. PLEASE PAY CAREFUL ATTENTION TO THE FLYER THAT WILL ACCOMPANY YOUR ORDER; IT TELLS HOW THE KM-3 FORMS ARE TO BE COMPLETED BEFORE AND AFTER HIPAA IMPLEMENTATION.

ATTENTION ALL DENTAL PROVIDERS

MEDICAID WILL RECYCLE CLAIMS FOR DATES OF SERVICE FROM MAY 1, 2003 UNTIL THE PRESENT FOR AMALGAMS AND RESIN COMPOSITES IN ORDER TO RECOVER OVERPAYMENTS MADE FOR EXACT DUPLICATE CLAIMS. THE RECYCLED CLAIMS WILL APPEAR AS VOIDS ON YOUR REMITTANCE ADVICE DATED SEPTEMBER 16, 2003. SHOULD YOU HAVE ANY QUESTIONS, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800) 473-2783 OR (225) 924-5040. 

NOTICE TO ALL PROVIDERS

WITH THE RECENT IMPLEMENTATION OF NCPDP 5.1 VERSION DUE TO HIPAA REGULATIONS, THERE WERE TECHNICAL ISSUES THAT WERE IDENTIFIED WITH THE MONTHLY PRESCRIPTION LIMIT EDIT. UNTIL THESE ISSUES WERE RESOLVED, IT WAS NECESSARY TO TURN THE MONTHLY PRESCRIPTION LIMIT EDIT FROM A DENY STATUS TO AN EDUCATIONAL STATUS FOR A SHORT PERIOD OF TIME. THE EDITS ARE AS FOLLOWS: 

575 - MISSING OR INVALID ICD-9 DIAGNOSIS CODE FOR RX OVERRIDE 
576 - MISSING OR INVALID PA/MC CODE OR NUMBER FOR RX OVERRIDE 
498 - NUMBER OF PRESCRIPTIONS GREATER THAN LIMIT 

WE APPRECIATE YOUR CONTINUED EFFORTS IN WORKING WITH THE MONTHLY PRESCRIPTION LIMIT. 

HOME AND COMMUNITY-BASED WAIVER SERVICES

FOR INFORMATION ABOUT HOME AND COMMUNITY-BASED WAIVER SERVICES AS AN 
ALTERNATIVE LONG TERM CARE OPTION, PLEASE CALL 1-800-660-0488.