RA Messages for November 25, 2008


If you are unsure about the coverage of a drug product, please contact the PBM help desk at 1-800-648-0790.  

Please file adjustments for claims that may have been incorrectly paid. Only those products of the manufacturers which participate in the Federal Rebate Program will be covered by the Medicaid program. Participation may be verified in appendix C, available at www.lamedicaid.com

Detailed FUL changes eff. 11/28/08 are posted on www.lamedicaid.com.


Policy Clarification
- Revocations must be submitted to the Hospice Program within 3 working days of the revocation. Any revocation submitted after the 3 day limit will become effective on the date of receipt. 


Effective with dates of service October 1, 2008, forward, the 2009 ICD-9 Disease and Procedure Classification Code Updates have been added to our files. Claims that have denied for invalid diagnosis/procedure codes prior to the loading of the 2009 ICD-9 data will be recycled and no action is required by the provider. Providers will be informed via RA message when the recycle will take place.


Effective with date of processing November 10, 2008, the logic changes for processing TPL claims for Home Health, LTC, ADHC, and Dental providers are now in place and effective for all TPL claims. These providers may also begin submitting TPL claims electronically. Logic changes for the Rehabilitation Center 102 paper claim form are also effective for this processing date. Changes for EDI claims submitted by Rehabilitation Centers and other providers submitting EDI claims with the 837P were effective in March of this year. Additionally, TPL claims claims paid using the new logic can now be adjusted - either electronically or hard copy. Updates will soon be made to the EDI Companion Guides as appropriate. TPL changes for ambulance transportation claims will be forthcoming. Please watch future RAs for this transition. Questions concerning these changes may be addressed to Unisys Provider Relations at (800) 473-2783 for general questions or the Unisys EDI Help Desk at (225) 216-6303 for technical questions concerning EDI billing.


Effective with date of processing Monday, December 1, 2008, the KIDMED Claims Processing Subsystem will be merged into the Medicaid Claims Processing System which processes all other Medicaid claims. This merge will be beneficial for KIDMED providers and should remove many of the current problem areas related to processing KIDMED claims through a separate subsystem prior to the claims data entering the regular Medicaid subsytem for processing. Current KIDMED claims reports will also be revised or eliminated. Detailed provider notices concerning this transition are being posted on the Home page and the New Medicaid Information link of the LA Medicaid web site, www.lamedicaid.com. Please visit the web site to obtain the details of this important transition that will affect you. After reviewing these notices, any questions may be directed appropriately to Unisys Provider Relations at (800) 473-2783, the Unisys EDI Helpdesk at (225) 216-6303, or the Unisys Web Technical Support Team at (877) 598-8753.


As reported earlier, we had a system problem that occurred on outpatient claims processed in the checkwrites dated 09/02/08 and 09/09/08. This problem caused the Units and Billed Charge fields on these claims to be expanded by one digit, and the claims were priced and paid accordingly. We have identified additional claims needing correction and will process systematic adjustments for the erroneously processed claims. No action is required on your part. Some of these claims were overpaid which necessitates a recoupment from the provider. Also, some of the claims will be adjusted to correct the incorrect Units or Billed Charges only, and there will be no adjustment/difference in the Medicaid paid amount for these claims. The systematic adjustments will be displayed in the Adjustment Claims/Previously Paid Claims sections of your remittance advice dated 11/25/08. We apologize for any inconvenience this error may have caused. Contact Unisys Provider Relations at (800) 473-2783 or (225) 924-5040 if you have questions.

The 2008 Holiday EDI Processing Schedule will be as follows

Tuesday 11/25/08 4:30PM - KIDMED deadline
Wednesday 11/26/08 10:00AM deadline - all claims (with exception of KIDMED and LTC)

Wednesday 12/24/08 10:00AM deadline - all claims (with exception of LTC)
Wednesday 12/31/08 10:00AM deadline - all claims (with exception of LTC)