RA Messages for February 09, 2009

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                 LMAC             Eff

Amiloride                     Tablet                5mg                                            off MAC         10/18/08
Carbamazepine             Oral Susp         100mg/5ml                                  .11848            01/20/09
Hyoscymaine Sulfate     Tab Susp          0.125mg                                     .61600            01/20/09

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. 

ATTENTION LTC PROVIDERS

When entering the Number of Days in the Value Code Fields 39, 40 or 41 of hard copy/paper UB claim forms, you MUST correctly follow the billing instructions which state: "Enter the appropriate Value Code in the "Code" portion of the field and the Number of Days in the "Dollar" portion of the "Amount" section of the field. Enter "00" in the "Cents" portion of the "Amount" section of the field."

Failure to enter "00" in the "Cents" portion of the field OR entering the number of days in the "Cents" portion of the field will cause the claim to deny. Additionally, these same instructions must be followed when submitting hard copy Medicare Crossover claims that do not cross automatically from the Medicare carrier. Failure to enter co-insurance days on Medicare crossovers when appropriate will result in claims denials for Code 087. Please make any needed changes to your software and/or procedures to ensure that this information is entered correctly on all paper claims for Medicaid.
 
Contact Unisys Provider Relations at (800)473-2783 or (225)924-5040 if you have questions concerning these instructions.

PROFESSIONAL SERVICES PROVIDERS
"Digital Mammography"

Effective with date of service July 1, 2008, Louisiana Medicaid will reimburse for digital mammography services, currently HCPCS codes G0202 (Screening mammography, producing direct digital image, bilateral, all views), G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views), and G0206 (Diagnostic mammography, producing direct digital image, unilateral, all views).

Providers should perform the most clinically appropriate method (film or digital) specific to the recipient. One screening mammography is allowed (either film OR digital) per female recipient aged 40-99, per calendar year.