RA Messages for March 18, 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.
TERBUTALINE SULFATE                                   VIAL                        1MG/ML             OFF MAC             02/25/08

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. PARTICIPATION MAY BE VERIFIED IN APPENDIX C, AVAILABLE AT WWW.LAMEDICAID.COM

 

ATTENTION PROVIDERS

EFFECTIVE WITH PROCESSING DATE MARCH 1, 2008, LA MEDICAID IMPLEMENTED CHANGES TO THE PROCESSING AND PAYMENT OF THIRD PARTY LIABILITY (TPL) CLAIMS. THIS CHANGE IS IN CONJUNCTION WITH THE EXPANSION OF THE LA HEALTH INSURANCE PREMIUM PAYMENT PROGRAM (LAHIPP). THESE CHANGES MAY AFFECT THE PAYMENT OF YOUR TPL CLAIMS. WITHIN THE NEXT WEEK, TRAINING MATERIALS AND OTHER DOCUMENTS RELATED TO THIS CHANGE WILL BE POSTED ON THE LA MEDICAID WEB SITE, WWW.LAMEDICAID.COM, LINK "TRAINING" - 2008 PROVIDER TRAINING MATERIALS. PLEASE REVIEW THIS INFORMATION CAREFULLY IN ORDER TO UNDERSTAND THE CHANGES MADE. IF YOU DO NOT HAVE WEB ACCESS, PLEASE CONTACT UNISYS PROVIDER RELATIONS (800-473-2783 OR 225-924-5040) TO OBTAIN A COPY OF THIS INFORMATION.
 


ATTENTION PROFESSIONAL AND DME PROVIDERS

EFFECTIVE WITH PROCESSING DATE APRIL 1, 2008 (CYCLE OF APRIL 7, 2008), LOUISIANA MEDICAID WILL ACCEPT AND PROCESS TPL CLAIMS SUBMITTED ELECTRONICALLY BY PROFESSIONAL AND DME PROVIDERS. IT WILL NO LONGER BE NECESSARY FOR THESE PROVIDERS TO SUBMIT TPL CLAIMS HARD COPY WITH EOBS ATTACHED. PROVIDERS MUST ENTER THE APPROPRIATE AND ACCURATE INFORMATION FROM THE PRIMARY PAYOR EOB FOR TRANSMISSION ELECTRONICALLY TO LOUISIANA MEDICAID FOR PROCESSING AND PAYMENT. DETAILED INFORMATION IS AVAILABLE IN THE 837P (PROFESSIONAL) COMPANION GUIDE LOCATED ON THE LOUSIANA MEDICAID WEB SITE, WWW.LAMEDICAID.COM, LINK "HIPAA BILLING INSTRUCTIONS AND COMPANION GUIDES." CONTACT SOFTWARE VENDORS AND/ OR UNISYS EDI FOR ASSISTANCE. PLEASE SEE THE WEB SITE FOR A MORE DETAILED NOTICE ON THIS TRANSITION. OTHER PROVIDER TYPES SHOULD MONITOR RA MESSAGES AND THE WEB SITE FOR INFORMATION CONCERNING EDI PROCESSING OF TPL CLAIMS.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
2007 REIMBURSEMENT RATE CHANGES

BASED ON FUNDING APPROPRIATED IN THE 2007 LEGISLATIVE SESSION AND APPROVAL BY CMS, DHH IS PLEASED TO ANNOUNCE REIMBURSEMENT RATE CHANGES FOR SELECTED PHYSICIAN SERVICES. EFFECTIVE FOR DATES OF SERVICE ON OR AFTER OCTOBER 15, 2007, THE REIMBURSEMENT FOR SELECTED PHYSICIAN SERVICES SHALL BE 90% OF THE 2007 LOUISIANA MEDICARE REGION 99 ALLOWABLE OR BILLED CHARGES, WHICHEVER IS THE LESSER AMOUNT. THE REIMBURSEMENT SHALL REMAIN THE SAME FOR THOSE SERVICES THAT ARE CURRENTLY BEING REIMBURSED AT A RATE THAT IS BETWEEN 90% AND 120% OF THE 2007 LOUISIANA
MEDICARE REGION 99 ALLOWABLE. FOR SERVICES THAT ARE CURRENTLY REIMBURSED AT A RATE ABOVE 120% OF THE 2007 LOUISIANA MEDICARE REGION 99 ALLOWABLE, THE REIMBURSEMENT FOR THESE SERVICES HAS BEEN REDUCED TO 120% OF THE
2007 LOUISIANA MEDICARE REGION 99 ALLOWABLE. PROVIDERS WILL SEE THE RATE CHANGES BEGINNING ON THE REMITTANCE ADVICE OF MARCH 18, 2008. NOT ALL CODES WERE IMPACTED BY THIS PROCESS.**  HOWEVER, THERE ARE SELECTED PHYSICIAN SERVICES THAT ARE STILL BEING ASSESSED FOR INCLUSION IN THE REIMBURSEMENT RATE CHANGE. PROVIDERS WILL BE NOTIFIED WHEN ADDITIONAL CODES ARE ADDED TO THESE RATE CHANGES.

THE PROFESSIONAL SERVICES FEE SCHEDULES THAT REFLECT RATES BEFORE AND AFTER THE CHANGES CAN BE FOUND ON THE 'FEE SCHEDULES' PAGE OF THE LA MEDICAID WEB SITE, WWW.LAMEDICAID.COM, LINK: 'FEE SCHEDULES'. THERE IS A SCHEDULE ENTITLED 'PROFESSIONAL SERVICES, LAB, X-RAY AND ASC REIMBURSEMENT/FEE SCHEDULE EFFECTIVE THROUGH DATE OF SERVICE OCTOBER 14, 2007', THAT DISPLAYS THE RATES PRIOR TO THE CHANGES; AS WELL AS A SCHEDULE ENTITLED, 'PROFESSIONAL SERVICES, LAB, X-RAY AND ASC REIMBURSEMENT/FEE SCHEDULE EFFECTIVE ON AND AFTER OCTOBER 15, 2007', THAT CONTAINS THE UPDATED RATE.

**ON THE HOME PAGE OF THE LOUISIANA MEDICAID WEBSITE, THERE IS ALSO A LINK FOR A "SUPPLEMENT TO THE PROFESSIONAL SERVICES FEE SCHEDULES". THIS SUPPLEMENT PROVIDES A LIST OF THE PROCEDURE CODES CURRENTLY INCLUDED IN THE MEDICAID REIMBURSEMENT CHANGE EFFECTIVE ON OR AFTER DATE OF SERVICE OCTOBER 15, 2007.

CLAIMS PAID AT THE PREVIOUS RATES WILL BE SYSTEMATICALLY RECYCLED. PROVIDERS WILL BE NOTIFIED WHEN AND HOW THE RECYCLE WILL OCCUR.

PLEASE MONITOR FUTURE RA MESSAGES AND THE LOUISIANA MEDICAID WEBSITE WHICH WILL INFORM PROVIDERS OF ANY ADDITIONAL UPDATES.