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 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. 

IMPORTANT UPDATE ON NCPDP D.0 AND 5010 270/271 TRANSACTIONS
IMPLEMENTATION EFFECTIVE JANUARY 1, 2012

A reminder that effective January 1, 2012, all electronic billings from Louisiana Medicaid pharmacy providers must be conducted using the HIPAA NCPDP D.0 version of the transaction standards. Pharmacy Point of Sale claims that are submitted in the NCPDP 5.1 format will be denied if received after 12/31/11 at 11:40 PM.

The Point of Sale system will be down from approximately 11:45 PM CST on 12/31/11 until 7:00 AM CST on 1/1/12 for the system changes to be implemented. We will bring the system up earlier if the implementation and monitoring of the changes require less time.

The MEVS (eligibility verification system) will be down for approximately 30 minutes beginning at 11:45 PM CST on 12/31/11. Recipient eligibility can be verified using MEVS, eMEVS, or REVS beginning approximately 12:15 AM on 1/1/12.

ATTENTION HOSPITAL, PHYSICIAN AND OUTPATIENT RADIOLOGY PROVIDERS
EFFECTIVE JANUARY 1, 2012, FOR THE RADIOLOGY UTILIZATION MANAGEMENT PROGRAM (RUM)

One new CPT code has been established for Computed Tomographic Angiography (CTA) study of the abdomen and pelvis. The code is 74174. This code becomes effective January 1, 2012, and is included in the Radiology Utilization Management (RUM) program. This code will require prior authorization (PA). The code description is listed below:

- 74174 Computed tomographic angiography; abdomen and pelvis; with contrast material(s), including noncontrast images, if performed, and image postprocessing

If prior authorization (PA) is not obtained for this procedure per the current RUM guidelines, then the procedure will not be payable by Louisiana Medicaid. For further information regarding RUM policy and procedure please visit www.lamedicaid.com.

IMPORTANT UPDATE CONCERNING CHANGES TO
THE ELECTRONIC CLAIMS STATUS INQUIRY (eCSI) APPLICATION

LA Medicaid's Claim Status Inquiry (eCSI) application has been modified support both 4010 and 5010 transactions. This will enable providers to choose which version of the application they want to use. The modified version will be available for use on Saturday, December 17, 2011. Once providers log into the LA Medicaid website, www.lamedicaid.com, select the Claim Status Inquiry application from the menu of web applications available. The 4010 version of the eCSI web application will appear. A new link has been added to this web page which allows a provider to navigate to the 5010 version of eCSI. To select use of the 5010 version, click the button located at the top center of the screen titled "Click Here for the ASCX12 5010 version of the eCSI application." Click the Help button at the top of the web page to view the User Guide.

On Saturday, December 17, 2011, this web application will be unavailable for approximately 2 hours between 6 a.m. and 8 a.m. while the change is being implemented. This dual version will be available for several weeks prior to the obsolete 4010 version being removed. Providers will be notified of when the 4010 version will no longer be available for use.