RA Messages for April 7, 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.
the PBM HELP DESK at
1-800-648-0790.
Please note the
following changes to Appendix A
DRUG
DOSE
STRGTH LMAC
EFF
NORMAL SALINE DISP. SYRINGE
2ml 0.9%
off MAC 3/19/09
NORMAL SALINE DISP. SYRINGE
2.5ml 0.9%
off MAC 3/19/09
NORMAL SALINE DISP. SYRINGE
3ml 0.9%
off MAC 3/19/09
NORMAL SALINE DISP. SYRINGE
5ml 0.9%
off MAC 3/19/09
NORMAL SALINE DISP. SYRINGE
10ml 0.9%
off MAC 3/19/09
NORMAL SALINE IV SOLUTION
25ml 0.9%
off MAC 3/19/09
NORMAL SALINE IV SOLUTION
50ml 0.9%
off MAC 3/19/09
NORMAL SALINE IV SOLUTION
100ml 0.9% off MAC
3/19/09
NORMAL SALINE IV SOLUTION
150ml 0.9% off MAC
3/19/09
NORMAL SALINE IV SOLUTION
250ml 0.9% off MAC
3/19/09
NORMAL SALINE IV SOLUTION
500ml 0.9% off MAC
3/19/09
NORMAL SALINE IV SOLUTION
1000ml 0.9% off MAC
3/19/09
NORMAL SALINE VIAL
2ml 0.9%
off MAC 3/19/09
NORMAL SALINE VIAL
10ml 0.9%
off MAC 3/19/09
NORMAL SALINE VIAL
20ml 0.9%
off MAC 3/19/09
NORMAL SALINE VIAL
100ml 0.9% off MAC
3/19/09
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.
OBSTETRICAL
ULTRASOUND POLICY CLARIFICATION
Louisiana
Medicaid's policy on obstetrical ultrasounds has been updated and
clarified. Providers submitting claims for these services are
responsible for, and expected to comply with, Medicaid policy. The
clarification is currently published on the Medicaid website homepage,
found at www.lamedicaid.com, and will also be published in an upcoming
edition of the "Louisiana Medicaid Provider Update."
ATTENTION
PROVIDERS
For
Medicaid pharmacy services effective May 1, 2009, the Department of
Health and Hospitals, Bureau of Health Services Financing will establish
a five-prescription limit per recipient per calendar month. Please refer
to www.lamedicaid.com for detailed information.
ATTENTION: CDC
HEALTH ADVISORY - VACCINE SHORTAGE
The
Centers for Disease Control and Prevention (CDC) has issued a Health
Advisory Alert regarding Haemophilus influenzae Type B disease and a
documented shortage of the vaccine for this disease. Included in this
alert are recommendations from the CDC for the provision of the vaccine
during this time of vaccine shortage. A link to this important Health
Advisory Alert can be found on the homepage of the Medicaid website,
www.lamedicaid.com. Louisiana Medicaid urges all providers of pediatric
vaccines to review this information. For further information on
Haemophilus influenza Type B conjugate vaccination, please visit the
LINKS Immunization Registry at
https://linksweb.oph.dhh.louisiana.gov/linksweb/main.jsp
ATTENTION ALL
PROVIDERS
Effective
March 30, 2009, HMS assumed the responsibility of updating the TPL
Resource Files for recipients with private insurance. A new form for
reporting TPL information updates was introduced in the Spring 2008 TPL
provider training workshops. At that time, providers were given the
option to either submit the form via fax or to continue to mail the form
with the affected claims to the TPL Unit. With the transition to HMS,
providers should discontinue submitting claims with the TPL Information
Update form. Effective immediately, the update form must be FAXED to HMS
at 1-866-976-2215. An EOB or carrier letter supporting the requested
update should be included when/if available. Any claims submitted with
these requests will not be processed; they will be considered
documentation only. Processing of your requests should only take one
week. Providers should hold any and all claims until the recipient file
is updated, then submit the claims through normal processing channels.
Providers should check this information through the recipient
eligibility options, e-MEVS, MEVS, or REVS, to ensure that the update
has occurred. The new TPL form, Medicaid Recipient Insurance Information
Update, is located on the homepage of the La Medicaid website,
www.lamedicaid.com, under the
link, "TPL Information." Questions concerning updates should be
addressed to HMS at 1-866-976-2210.
TAKE CHARGE/FAMILY PLANNING
WAIVER PROVIDERS
Medicaid does NOT cover Essure
(procedure codes 74740, 58565 and 58340)
for Take Charge. In early March DHH told some providers it was a covered service
but we cannot cover this service until we update the waiver documents with federal government and receive CMS approval. DHH apologizes
for the miscommunication and will keep providers updated via RA messages
and provider updates.
ATTENTION EARLYSTEPS PROVIDERS
EarlySteps claims for select
procedures provided in the Natural Environment and impacted by the reimbursement rate change effective for dates
of service 9/1/08 and after are being systematically adjusted to reflect
the updated reimbursement rates if the billed charges were greater than
the previous fee on file. These adjustments will appear on the RA of
3/31/09. No action will be required by providers. See the RA message
dated 1/20/09 for details.
Claims where the billed charges were less than or equal to the previous
fee on file will not be included in this systematic adjustment. For this
situation, if providers determine adjustments are needed, providers
should review the claim adjustment policy and procedures in the 2007
Louisiana Medicaid EarlySteps Provider Training manual, pages 31-36.
Contact Unisys Provider Relations at (800) 473-2783 or (225) 924-5040
with any questions.
ATTENTION PHYSICIANS AND
HEMODIALYSIS CENTER PROVIDERS
In order to prevent claims
requiring NDC data from processing differently during the same weekly cycle, the implementation of NDC denial edits
will occur on processing date Monday, 4/6/09, rather than Wednesday,
4/1/09. This will allow all claims submitted within the same weekly
cycle to process using the same logic instead of possibly having some
claims process and pay with educational edits and others deny. Please be
aware of this processing date change for NDC denials. Also, please remember that this affects claims with dates of service 3/1/08 forward.
LUPRON DEPOT THERAPY FOR
PROSTATE CANCER
Updates have been made to
the claims processing system to allow reimbursement for multiple units
of Lupron Depot 7.5mg IM (J9217) to be administered on the same date of
service to a recipient when medically indicated for the treatment of
prostate cancer. It continues to be the Department's intent that
provision of this medication other than for the treatment of prostate
cancer is not reimbursable in Medicaid's 'Professional Services'
program. A systematic adjustment of inappropriately denied or 'cutback'
claims will be made. No action is required by providers. Notification
will be made via remittance advice messages when the adjustments occur
in the near future.
NOTICE TO HOSPITAL PROVIDERSS
DELAY IN IMPLEMENTATION OF NDC DENIAL EDITS FOR OUTPATIENT
HOSPITAL CLAIMS
DHH has learned that
Medicare will implement the requirement for transmitting NDC data on
electronically submitted claims effective 7/1/09. In an effort to allow
hospital providers to make any systems changes needed to accommodate
both the Medicaid and Medicare requirement, we are postponing the
implementation of Medicaid claim denial edits related to the entry of
NDC data on claims for outpatient hospital claims until 7/1/09.
Edits related to NDC claim
data will continue to be educational edits through 6/30/09. The NDC
edits are 120, 127, and 231.
The NDC data requirement is applicable for claims with dates of service
3/1/08 forward. Thus, any claim resubmittals with dates of service on or
after 3/1/08 will deny beginning with processing date 7/1/09 if the
necessary NDC data is not present on the claim.
This is the final delay by
LA Medicaid of the implementation of claim denials.