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. 

TO ALL LOUISIANA PHARMACIES

Please be informed that the Louisiana Department of Health and Hospitals (DHH) has received a public records request for pharmacy data related to the Survey of the Average Cost of Filling a Medicaid Prescription in the State of Louisiana recently conducted by Myers & Stauffer, L.L.C. DHH is hereby notifying you of this public records request. A sample of what will be disclosed pursuant to the public records request has been sent to your stakeholder representative for review. The data is de-identified and does not contain protected information, however, if you believe that the requested data contains protected information and disclosure thereof will compromise your interest; please take the appropriate legal action to restrain DHH from disclosure. The requested information will be released to the requestor on February 1, 2012, unless legal action is taken before that date to restrain DHH from making the disclosure.

Stakeholders:

Doug Robichaux - doug@healthcare-pharm.com 
Bernard LeBas - lebasb@legis.state.la.us 
Allan Hansen - ahansen@mslc.com 
Fred Mills - mills@legis.state.la.us, fred@fmbanking.com
James Shin - jshin@mslc.com 
Kris Knerr - Kknerr@mslc.com 
Kevin McCarter - Kevin.mccarter0@wal-mart.com 
Linda Spradley - linda@spradleyandspradley.com 
Phyllis Perron - pperron@pperron.com 
Sonya Hall - shall@mslc.com 
Mary Staples - mstaples@NACDS.org 
Bud Courson - bud@coursonnickel.com 
Randall Johnson - johnson@lipanow.org 

ATTENTION PROFESSIONAL, DME, HOSPITAL, AND HEMODIALYSIS PROVIDERS
THAT MUST BILL CLAIMS USING NATIONAL DRUG CODES (NDC)

Effective with the remittance advice (RA) dated 01/18/12, the LA Medicaid Online RA has been changed to include the National Drug Code (NDC) when it is submitted on a claim from the provider. This information will appear immediately below the procedure description on the affected RA claim line. This change does NOT affect the online RAs for pharmacy providers submitting drug claims through POS. The positioning of the NDC data for these RAs/claims will remain the same. This change also does NOT affect NDC data returned through the 835 electronic remittance advice. The return of the NDC data for 835s will remain the same.

ATTENTION PRIMARY CARE PROVIDERS (PCPs)

Have you enrolled with a BAYOU HEALTH Plan yet? If not, starting with dates of service 2/1/12, you will no longer receive reimbursement for providing services to Louisiana Medicaid recipients who reside in the New Orleans or Northshore Regions (Orleans, Jefferson, St. Bernard, Plaquemines, St. Tammany, Washington, St. Helena, Livingston, and Tangipahoa Parishes) and are enrolled in a BAYOU HEALTH Plan unless you have contracted with, or made other arrangements with the BAYOU HEALTH Plan the recipient is linked to on the date of service. For further information, visit the website at www.makingmedicaidbetter.com or participate in daily phone calls with DHH being held Monday through Friday (from noon - 1:00 p.m.) by calling 1-800-278-0296, pass-code 7299088.

VERIFYING HEALTH PLAN & ELIGIBILITY INFORMATION FOR BAYOU HEALTH MEMBERS

Beginning 2/1/12, REVS, MEVS, and E-MEVS applications will show the name of the BAYOU HEALTH Plan and their phone number for Medicaid recipients enrolled in BAYOU HEALTH. Enrollment in a BAYOU HEALTH Plan is for the entire calendar month. This information will be located where current CommuniyCARE PCP information is, and will no longer contain the PCP name. You may obtain PCP information from the BAYOU HEALTH Plan. DHH is making revisions that will allow future month Health Plan and eligibility information to be shown in these applications. Further information will be forthcoming.