RA Messages for January 19, 2010
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
DOSE
STRGTH
FUL
EFF
NITROGLYCERIN
TAB SUBL
0.3MG OFF LMAC
12/14/2009
NITROGLYCERIN
TAB SUBL
0.4MG OFF LMAC
12/14/2009
Detailed LMAC and FUL
changes are posted on
www.lamedicaid.com.
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.
PLEASE NOTE
THE FOLLOWING
Pharmacy
providers are advised that there will be a delay in implementing the new
Louisiana Allowable Costs (LMACS) rates.
ATTENTION
PROFESSIONAL SERVICES ANESTHESIA PROVIDERS
IMPLEMENTATION OF REIMBURSEMENT RATE REDUCTIONS
Effective
with dates of service on or after August 4, 2009, the reimbursement
rates for anesthesia services that are performed under the professional
licensure of a physician (anesthesiologist or other specialty) are
reduced by 3.5% of the fee amounts on file as of August 3, 2009. An
emergency rule regarding these reductions was published in the August
20, 2009, issue of the Louisiana Register.
Providers
will begin seeing these reductions on the RA of January 5, 2010. Claims
for date of service August 4, 2009, that were adjudicated prior to
January 5, 2010, will be systematically adjusted and no action is
required by providers. Providers should monitor future RAs for updates
regarding these adjustments. Notification will be made via remittance
advice message when the recycle occurs. Effective for dates of service
on or after November 20, 2009, maternity-related anesthesia services and
anesthesia services rendered to recipients under the age of 16 shall be
exempt from the August 4, 2009, rate reduction on anesthesia services
performed by a physician (anesthesiologist or other specialty). An
emergency rule was published regarding this amendment in the November
20, 2009, issue of the Louisiana Register.
TAKE CHARGE
FAMILY PLANNING WAIVER COVERAGE
CLAIMS PAID IN ERROR TO BE VOIDED
The TAKE
CHARGE Family Planning Waiver Program has coverage limited to specific
services/provider types, including physician services, outpatient
hospital services, and pharmacy services. We have learned that claims
for programs other than those covered (i.e., inpatient hospital, home
health, DME, and transportation) were paid in error for these
recipients. The logic for processing claims for the TAKE CHARGE Program
has been changed and two new edits activated to deny claims billed by
providers not covered by this program. The edits are: Edit 544 = CLAIM
TYPE/FORMAT NOT COVERED BY THE FPW PROGRAM, and Edit 541 = INPATIENT
SERVICES ARE NOT COVERED BY THE FPW PROGRAM. Claims paid in error will
be voided on the RA of January 19, 2010. We continue to strongly
encourage providers to check recipient eligibility to confirm
eligibility and any coverage restrictions the recipient you are seeing
may have.
ATTENTION LAB
& RADIOLOGY (NON-HOSPITAL) PROVIDERS
SYSTEMATIC CLAIMS ADJUSTMENT FOR DELAYED RATE REDUCTIONS
Lab & radiology claims impacted by the
rate changes effective August 4, 2009, are being systematically adjusted
for claims that were paid incorrectly as a result of a delay in
implementation. Due to the large claims volume, the recycle will occur
over two weeks in numerical order by billing provider number with the
RA's of January 26, 2010 (Claim ICN range of 0010222000100 -
0010283739200) and February 2, 2010 (Claim ICN range of 0017222000100 -
0017272663000). Adjusted claims for each billing provider will appear on
only one of the RA's. No action is necessary by providers. Please
monitor your RA's to determine which date your claims were recycled.