RA Messages for January 15, 2008
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 NOTE THE FOLLOWING CHANGES TO APPENDIX A:
DRUG
DOSAGE STRGTH
MAC
EFF
ANTHRALIN
CREAM(GM)
1% OFF MAC
01/04/08
ERGOLOID MESYLATES
TABLET
1MG OFF MAC
01/04/08
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. PARTI-
CIPATION MAY BE VERIFIED IN APPENDIX C, AVAILABLE AT
WWW.LAMEDICAID.COM
URGENT: Attention Providers
AND BILLING VENDORS
THE FEDERAL STATUTE REQUIRING THE USE OF THE NATIONAL DRUG CODE (NDC) ON
CLAIMS FOR PHYSICIAN ADMINISTERED DRUGS EFFECTIVE JANUARY 2008 WILL BE
IMPLEMENTED IN THE MEDICAID CLAIMS PROCESSING SYSTEM AND WILL RESULT IN
DENIAL OF NON-COMPLIANT CLAIMS IN THE NEAR FUTURE. THE NDC NUMBER AND
THE HCPCS CODE FOR DRUG PRODUCTS WILL BE REQUIRED ON THE 837P, THE
CMS-1500,THE 837I, AND THE UB04 CLAIM FORMS FOR REIMBURSABLE
MEDICATIONS. THE EFFECTIVE DATE OF THE NDC REQUIREMENT ON SYSTEM EDITS
HAS NOT YET BEEN DETERMINED. PROVIDERS AND BILLING
VENDORS ARE REQUESTED TO IMMEDIATELY BEGIN UPDATING THEIR BILLING
SYSTEMS, COMPLETE THE NECESSARY CHANGES TO INFORMATION SYSTEMS, AND
UPDATE INTERNAL POLICIES AND PROCEDURES TO ENSURE THAT THESE
REQUIREMENTS ARE MET. BILLING INSTRUCTIONS CAN BE FOUND IN THE 2007
TRAINING MANUALS FOR PROFESSIONAL SERVICES, KIDMED, AND RHC/FQHC
SERVICES IN THE SECTION OF INFORMATION PERTAINING TO THE CMS-1500 FORM.
BILLING INSTRUCTIONS FOR THE
UB04 AND 837I WILL BE FORTHCOMING. PROVIDERS WILL BE GIVEN SUFFICIENT
TIME TO MAKE THE NECESSARY CHANGES TO THEIR BILLING SYSTEM PRIOR TO
IMPLEMENTATION.
PROVIDERS AND BILLING VENDORS MUST MONITOR THE LOUISIANA MEDICAID
WEBSITE AT WWW.LAMEDICAID.COM
AND REMITTANCE ADVICE MESSAGES FOR IMPORTANT INFORMATION REGARDING THE
DATE OF IMPLEMENTATION AND FURTHER INSTRUCTIONS.