Unisys Name Change The PE-50 Form
Provider Relations EMC Submitters - Reminder
KIDMED Providers - New Management and New Services HCFA 1500 Billers and the Prior Authorization Number
Therapeutic Passes Hospitalized Nursing Home Residents
Form 152-N Exhausted Medicare Part A Benefits Claims
Correct Procedures for Claims Resolution Electrocardiograms for Medicare/Medicaid Recipients
Desipramine HCL Pharmacy Program Revisions
Amendments to Appendix C LADUR Education Article
Rate Increase for Emergency Ambulance Providers NEMT Insurance Requirements

Analysis of DME Denials

Unisys Name Change

Unisys/LA. Medicaid is now operating under the name Paramax Systems Corporation, a Unisys company.  Paramax Systems Corporation, headquartered in McLean, Virginia, is a $2 billion information systems company with 17,000 employees.  A subsidiary of Unisys Corporation, Blue Bell, Pennsylvania, Paramax is an experienced leader in complex systems integration, custom electronic products, and related professional services for civil and defense agencies of the U.S. Government, Canada, and nations on five continents.

Our recent name change, however, need not concern the Medicaid provider community in Louisiana.  Now, more than ever, we are dedicated to meeting our customer's needs and expectations.  Paramax has a long history of proven performance and a long list of satisfied customers.

Paramax is market-driven and technology-enabled.  Simply put, we develop and apply leading-edge technologies to meet our customer's needs and requirements.  We blend our technical substance with a corporate style that stresses quality, cost-effectiveness, program performance, and partnership with our customers.

Ultimately, what makes Paramax special is the proud reputation we've achieved among our customers for being a responsible contractor, for keeping promises, for getting the job done.

Our promise to the provider community of Louisiana is to build on our core strengths and to forge new partnerships in the years to come.

The PE-50 Form

When completing the Provider Enrollment Form (PE-50), providers should submit a one-page form (front and back).  In other words, providers should not submit the form on two separate pages.

In addition, providers should ensure that the PE-50 has an original signature.  Stamped or copied signatures are not accepted.

Provider Relations

The Provider Relations inquiry staff strives to respond to provider inquiries quickly and efficiently.  However, due to the number of incoming calls for other departments that must be transferred out of Provider Relations, the inquiry staff is having difficulty responding to Provider Relations related inquiries in a timely manner.  Thus, to help us serve the provider community better, we are requesting that providers telephone Provider Relations only when they have questions concerning printed policy, claims processing problems, or the status of particular claims.

NOTE:  We request that providers review and reconcile their Remittance Advices before they call Provider Relations for the status of a claim.

Providers who have questions concerning EMC may telephone (504) 924-7051.

Providers who have questions concerning Prior Authorization may telephone (504) 928-5263 or 1-800-488-6334.

NOTE:  PA claims billing problems, however, should be addressed to Provider Relations.

Providers requesting check amounts, eligibility information, and the number of remaining recipient days or visits may call our VIPS line at 1-800-776-6323.

NOTE:  Effective immediately, we are no longer able to transfer providers out of Provider Relations to other departments.

HCFA 1500 Billers and the Prior Authorization Number

Providers billing on the HCFA 1500 form with a Prior Authorization number will not be paid if they simply attach the PA form to the claim form and do not enter the PA number in the correct block on the claim form.  The PA number must be entered in Block #23B and the PA form must be attached to the claim form in order for the claim to be paid.

EMC Submitters


Providers have been mailing or submitting claims directly to the EMC Unit rather than mailing them to the correct EMC Post Office Box.  Using the EMC label with the appropriate box number will decrease the processing turnaround time.

KIDMED Providers

New Management and New Services

Birch & Davis Health Management Corporation, Inc. (BDHMC), under contract to DHH will begin administering the KIDMED (EPSDT) Program on February 17, 1992.  Effective March 1, 1992, a new KIDMED screening claim form must be used for all KIDMED medical, vision, and hearing screening claims.  During the month of February, providers were trained on the administrative aspects of KIDMED.

KIDMED will offer various services to support providers, including linking eligibles with providers, Denver II Developmental Screening Test training, review and authorization of screening claims, and assistance with denied claims.  Also, at the provider's request, KIDMED is available to schedule screening appointments for children 12 months of age and older and to arrange transportation.

A provider representative is available in the Baton Rouge KIDMED office to assist providers and may be reached at 1-800-259-8000 or (504) 928-9683 in Baton Rouge.

Hospitals and Physicians

Therapeutic Passes

Medicaid of Louisiana is aware of the importance of temporary leave of absence or therapeutic pass from the hospital in the treatment of psychiatric and rehabilitative patients.  However, it would be contradictory to our policy to pay the per diem rate for a day of service when the patient was not in the facility to receive any services.  Consequently, therapeutic pass days are not considered covered days under our program and should be reflected as non-covered days on the UB-92 claim form regardless of the length of absence.

In addition, providers should note that the medical necessity for the therapeutic pass must be documented in the patient's chart by the attending physician, and any pass exceeding 72 hours must be considered a discharge.

Providers may consult pages 11-7 and 11-8 of the Hospital Services Provider Manual for instructions on how pass days should be recorded on the claim form.

NOTE:  Only one leave of absence may be included on a claim form.

Hospitalized Nursing Home Residents

When a nursing home resident is admitted to a Distinct Part Psychiatric Unit of an acute care hospital, Medicaid of Louisiana will pay to reserve the recipient's nursing home bed for 10 days per hospitalization just as it does for an acute care admission.  In the event of the hospitalization exceeding 10 days, the recipient or his family may pay the nursing home to continue to reserve a bed.

The practice of discharging the patient for 24 hours and then readmitting him in order to "protect" his nursing home bed is contrary to policy for both the Long Term Care program, as well as the Hospital program.

Form 152-N

Form 152-N (Title XIX Medical Assistance Medical Eligibility Inquiry for Newborns) is the form used to verify a child's birth to a Medicaid recipient.  This form serves as documentation of the child's name, date of birth, race, and enumeration.  Provided below is information concerning the requisition, completion, routing, and processing of the Form 152-N.

Requisitioning Forms

Supplies of the Form 152-N must be requested in writing.  Providers should send their requests to Paramax Systems Corporation at the following address:

Paramax Systems Corporation
8591 United Plaza Blvd.
Baton Rouge, LA  70809
Attention:  Forms Distribution

Paramax Systems Corporation will then route the request to the State Division of Administration warehouse, which will be responsible for filling the request.  The Eligibility Operations Section, which handles the deeming of eligibility process, cannot order forms, verify the order, or check on the status of the order.  Providers should ensure that the return address for the order is a street address, not a box number.

Completing the Form

Providers should type or print all information on the form.  If printing the information, providers should use a hard tipped pen and bear down hard enough so the third carbon is legible.

Providers should not attach proof of birth or acknowledgement of paternity to the form.  The Form 152-N serves as proof of birth and/or relationship to the mother.  Acknowledgements of Paternity should be sent to the parish Office of Family Support.

Providers should complete every block on the form.  They should provide full names -- first name, middle name or initial, and last name -- for the mother, father (if appropriate), and the newborn.  We cannot assume that the child and the mother have the same last name, so the provider must specify the newborn's last name.  The entries labeled Mother's Phone Number, Medical Record Number, and Patient Account Number are the only optional entries on the form.  However, it is important to include a phone number to assist in making referrals for KIDMED services.

Full addresses for the physicians to whom forms must be sent must be provided, and zip codes must be included on each form.  Stamps may be used for the addresses.

For provider groups, the group name and address should be used on the forms, so that mailing may be consolidated to one mailing per day to the group.  We recommend that the group stamp be used in the address portion of the form.

A form will be sent to each provider listed on the form.  It is not necessary for each provider (the hospital and each physician) to complete a separate form.  If the doctor's name and address are provided on the form completed by the hospital, it is not necessary for the doctor(s) to complete another request.  Redundant requests will be completed but will slow the process.

Usually, physicians other than the pediatrician and the OB/GYN should not be included on the form.  The names and addresses of the specialists should be included only when services have been provided by a specialist and the Medicaid number for the newborn is needed for billing services that have already been provided.

Mothers will be issued monthly medical cards.  For future care, providers should have the client present the monthly medical card.

Routing the Form

Providers should route the form to the state Eligibility Operations Section in Baton Rouge only when the mother is already eligible and is already receiving Medicaid on the date of the child's birth.  The Eligibility Operations Section cannot determine the eligibility of the mother or complete a pending application.  If the mother has an application pending for Medicaid, the Form 152-N should be sent to the Office of Family Support in the parish in which the mother is a resident.  The Form 152-N may be used by the parish office as proof of the birth.

If the mother has not applied for Medicaid prior to the birth, she should be referred to the parish Office of Family Support, and the provider should give her some proof of birth for the baby because she will need to present proof at the time of application.

Processing at BHSF

The Eligibility Operations staff will process the Form 152-Ns in the date order of receipt.

When the forms arrive, they are date stamped and logged in for processing in order of receipt, and the Eligibility Operations staff makes every effort to meet the 10-day turnaround timeframe on the forms.  The 10-day timeframe starts on the date of receipt; the timeframe does not begin on the date of birth or the date the form was mailed from the provider's office.

Forms which do not include all identifying information for the mother or the child will be returned to the hospital/physician for completion.

When forms are completed with only the physician's last name, e.g., Dr. Black, a copy of the form cannot be provided to the physician unless there is complete address provided for the physician.  The Eligibility Operations staff will not conduct research to determine the provider name and address.

Forms on which the hospital's/doctor's name is complete but on which there is no address or there is an incomplete address will be mailed but will be delayed until the name and/or address can be researched.  Researching addresses will not be given priority over regular processing.

Hospitals Only

Exhausted Medicare Part A Benefits Claims

It has come to our attention that hospitals are experiencing difficulty in receiving reimbursement for Medicare/Medicaid claims when the Part A benefits have been exhausted.  To facilitate the reimbursement of such claims, we request that providers submit these crossover claims with documentation of the Part A benefits being exhausted, such as a notice of Medicare Claim Determination or a Medicare Part A EOB.  A copy of the Medicare Part B EOB must also be attached to the claim.

In addition, for bill type 111, the dates of service on the notice of Medicare Claims Determination or the Part A EOB must match the date of service on the claim in order for the exhaustion of the Part A benefits to be verified.

NOTE:  Providers should note that all such claims should be submitted to the attention of Peggy Misner at the Unisys Post Office Box for crossover claims, P. O. Box 91023.

Correct Procedures for Claims Resolution

It has come to our attention that there is a misunderstanding among providers regarding the correct procedure for claims resolution.  If a claim is over one year old, then it must be submitted to Unisys Provider Relations with a request for an override of the timely filing limitations and documentation which reflects that the claim was originally timely filed.  Documentation of timely filing may be a remittance advice or correspondence from either Unisys or the Bureau of Health Services Financing which identifies the claim and reflects that it was filed within one year of the date of service.

If a claim is over two years old, then it must be submitted to the Hospital Program with a request for an override of the timely filing limitation, documentation of timely filing, and documentation of the provider's attempt to resolve the billing problem.  If the provider does not have documentation of timely filing because the patient became eligible for Medicaid retroactively, then the claim must be submitted to the MMIS Section with documentation of retroactive eligibility.  Documentation of retroactive eligibility may be either a copy of the patient's Medicaid eligibility card or correspondence from the local Office of Family Support which identifies the period of retroactive eligibility.

NOTE:  Claims involving retroactive eligibility must be submitted to MMIS within one year of the patient becoming Medicaid eligible.

Claims requiring resolution should be sent to one of the following addresses:

One Year Old:

Paramax Systems Corporation
P. O. Box 91024
Baton Rouge, LA  70821
Attention:  Provider Relations 

Two Years Old:

P. O. Box 91030
Baton Rouge, LA  70821
Attention:  Sandra Victor, Hospital Program

Retroactive Eligibility:

P. O. Box 91030
Baton Rouge, LA  70821
Attention:  Cathy Troy, MMIS Claims Resolution 

Providers should note that compliance with these guidelines for claims resolution will facilitate the processing of claims.

Physicians Only

Electrocardiograms for Medicare/Medicaid Recipients

Effective with date of service January 1, 1992, for Medicare/Medicaid recipients only, reimbursement for the interpretation of electrocardiograms, procedure codes 93000, 93010, 93040, and 93042, will be included in the provider's fee for the office, hospital, or consultation visit.  However, these procedure codes will remain payable for straight Medicaid recipients.

Pharmacists & Prescribers

Desipramine HCL

Effective for services beginning December 11, 1991, the Federal Upper Limits on Desipramine HCL (generic name), 10 mg. tablets, have been suspended.

Pharmacy Program Revisions

The pharmacy program has revised the requirement that prescriptions be filled initially within 10 days of the date prescribed and the requirement that prescriptions for Schedule II narcotic analgesics be filled within 24 hours.  The new requirements state that prescriptions should be filled within six months of the date prescribed  and the prescriptions for Schedule II narcotic analgesics should be filled within 5 days of the date prescribed.  Transfer of a prescription from one pharmacy to another is allowed if less than 6 months has passed since the date prescribed, and in accordance with the Louisiana Board of Pharmacy regulations. The effective date of these revisions is January 21, 1992.

Amendments to Appendix C

Providers should make the following corrections to the 10/18/91 printing of Appendix C:

Manuf. Code

Pharmaceutical Company



Eff. Date


Cord Laboratories, Inc.

Off Prog.



Blaine Company, Inc.




Konsyl Pharmaceuticals




Obetrol Pharmaceuticals




Rexar Pharmaceutical Corp.




Landry Pharmaceuticals, Inc.




Perry Medical-Hall Laboratories




Hydromag Int. Ltd.

Off Prog.



Spectrum Chemical Mfr. Corp.




Hermal Pharmaceutical Labs




Spectrum Chemical Mfr. Corp.




Xactdose, Inc.

Off Prog.



American Dermal Corporation




Clinical Pharmaceutical, Inc.




Johnson Laboratories, Inc.




Scandipharm, Inc.




American Pharmaceuticals




American Generics, Inc.




Martin Elwealor Pharm., Inc.




Reliable Drugs




Medi-Plex Pharm., Inc.




Ross Laboratories



LADUR Provider Education:  Anti-Anxiety Drugs (H2F)

Program Statistics:

Drug expenditures for this therapeutic class represents 2.0% ($3,066,631) of the total drug program expenditures during the last fiscal year (7/1/90 to 6/30/91).  During the first five months of the current fiscal year, 2.4% of payments were for anti-anxiety agents.  In addition, 172,224 anti-anxiety prescriptions were filled fiscal year 1990/91.

Expenditure examples include the following:



Average Payment/Rx



Total Paid*






































*               Reflects ingredient cost + dispensing fee (7/1/90 to 6/30/91).  Generics not totaled.

Combination Use of Anti-Anxiety Agents:

Currently, there are several anti-anxiety agents available for use in the treatment of acute anxiety.  Most are classified chemically as benzodiazepines.  In addition to these, there are older agents, e.g., meprobamate, and newer agents, e.g., buspirone, in common use.  Although all the benzodiazepines are thought to act primarily through similar mechanisms of action, it is clear that slight differences in these agents may justify the selection of a unique agent for a particular indication.

Based on duration of action, the anti-anxiety agents may be broadly classified as either short, intermediate, or long acting.  These differences in duration of action are largely due to differences in absorption, distribution, metabolism, and/or elimination.  The unique characteristics of each agent may cause a physician to prefer one benzodiazepine over another.  However, there is not documentation to the added value of the use of multiple anxiolytics in a single patient when the agent is used solely for the treatment of anxiety in individual patients.

Short-Term Use of Combinations of Anti-Anxiety Agents:

While combinations of anti-anxiety agents are not considered useful in the treatment of anxiety, there may be circumstances where the use of combinations of anti-anxiety agents for short periods of time might be expected.  One use might be the continuation of benzodiazepine anti-anxiety agent.  Generally, this switch can be accomplished by the combined use of buspirone with a benzodiazepine for two to four weeks during the initiation of busipirone therapy.  Such a switch presupposes an intention to discontinue appropriately the benzodiazepine after a period of concomitant therapy.  Another circumstance where the use of combinations of anti-anxiety agents might occur is when attempts are made to switch a patient from a shorter-acting benzodiazepine to a longer-acting agent from the same class.  A third situation would be the prolonged use of a single benzodiazepine during the withdrawal process while slowly tapering dosages.  While tapering guidelines generally suggest a period as short as four weeks, experience dictates the need for tapering benzodiazepine dosages over periods as long as twelve weeks.  Benzodiazepine withdrawal syndrome is a medically debilitating latrogenic situation that requires careful monitoring by a physician.

Tapering Schedules:

Tapering of benzodiazepine dosages in patients addicted/tolerant to the benzodiazepines has become accepted therapy.  Without an adequate period of tapering, the patient may be subject to a variety of usually successful but potentially serious adverse reactions.  Therefore, the clinical literature is strongly supportive of the need for tapering benzodiazepine withdrawal or at least monitoring the risks associated with benzodiazepine withdrawal.  Currently accepted protocols include, but are not limited to, a 10% reduction in dosage at weekly intervals.  Generally, a period of six of twelve weeks is required in such tapering programs.  An evaluation of patient profiles usually shows some evidence of the tapering of dosages.

New uses of benzodiazepine in the treatment of panic disorders often result in the use of higher than usual doses of anti-anxiety agents, which may result in situations where patients become dependent upon higher dosages of these agents.  Caution should be exercised during implementation of withdrawal programs in these patients because of the increased potential for serious withdrawal symptoms.  A longer tapering schedule may need to be employed.  References available upon request.

Transportation Providers

Rate Increase for Emergency Ambulance Providers

According to the new Louisiana state law passed last July, 1990, Medicaid is required to pay the same amount as Medicare for emergency ambulance services.  Consequently, effective January 1, 1992, a rate increase for Medicaid Emergency Ambulance services has been approved.  The new rates, as well as the old rates, the corresponding codes, and their descriptions are listed below.

NOTE:  Providers will be paid only for a maximum of one emergency base rate and/or one emergency transfer rate service per recipient per day.

Emergency Ambulance Transportation Rates (Eff. 1/1/92)

Description of Procedure Code


Old Amount


New Amount



Base Rate Basic Life Support




Base Rate Advanced Life Support




Transfer Rate (BLS)




Transfer Rate (ALS)




Vehicle Miles, Advanced Life Support




Vehicle Miles, Basic Life Support




Base rate Advanced Life Support, where non-reusable supplies are billed separately (For use only with Medicare crossovers; the payment amount equals the Medicare and Medicaid combined payments.)




NEMT Insurance Requirements

Medicaid policy requires that each provider maintain insurance coverage on all vehicles.  This means that the insurance polices must be in the provider's name, not in the driver's.  In addition, the Bureau of Health Services Financing must be listed as the party to be notified in the event of cancellation.  Coverage maintained must provide, at a minimum, liability insurance for the amounts of $100,000 per person and $300,000 per accident, or a $300,000 combined service limits.  The liability service policy must cover specifically described autos, hired autos, and non-owned autos.

Analysis of DME Denials

Due to the high denial rate of DME claims, we decided to analyze the first four checkwrites of December, 1991, to determine the reason why so many DME claims are being denied.

Our analysis showed that 1443 claim lines were denied during this period.  Then, we broke down the reasons for the denials into eight categories.

The results of our analysis are as follows:

Categories and Percentages of DME Denials

Error Category

Percentage (%)


1.     Recipient


2.     Provider


3.     Procedure Code


4.     Diagnosis Code


5.     TPL or Medicare Coverage


6.     Duplicate Claim


7.     Other, i.e., invalid dates


8.     Prior Authorization Related Denials


The Prior Authorization related denials were analyzed further.  We found that the largest number were denied for "Procedure Requires PA."  The second largest category was for "Date of Service Not Covered by PA."  Also, there were quite a few denials for "Claim Exceeds PA Limit."  The remaining categories were less than 1.5%.

Paramax Systems Corporation wants providers to get their claims paid on the first submission; therefore, we would like to assist providers with billing problems.  Providers who have billing problems should contact our Provider Relations Department to schedule a visit from one of our field analysts.  They are available to train providers' billing personnel in billing for Medicaid claims of all types.