RA Messages for May 06, 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                                                                 DOSE                     STRGTH                         MAC                     EFF.
DISULFIRAM                                                     TAB                         250MG                     OFF MAC             04/18/08
HEPARIN SODIUM,PORCINE 5ML                 VIAL                       10,000 U                     $1.955                 03/18/08
PSEUDOEPHED HCL/CHLOR-MAL              CAP SR                     120-8MG                     $1.38                  03/10/08
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

 

ATTN PHARMACY PROVIDERS:

WE ARE UPDATING CONTACT INFORMATION ON PRESCRIBING PROVIDERS WHO HAVE CLOSED ENROLLMENT. YOU MAY RECEIVE AN EOB 489 (PROVIDER TYPE NOT AUTHORIZED TO PRESCRIBE) MAPPED TO NCPDP REJECTION CODE 25. CALL THE HELP DESK AT 1-800-648-0790 OR PROVIDER ENROLLMENT AT 225-216-6370 FOR CLARIFICATION.

ATTENTION HOSPITAL, HOME HEALTH, HEMODIALYSIS PROVIDERS

EFFECTIVE WITH PROCESSING DATE MAY 23, 2008, YOU MAY BEGIN SUBMITTING TPL CLAIMS ELECTRONICALLY ON THE 837-I(INSTITUTIONAL TRANSACTION). YOU MUST ENSURE THAT YOU ARE ENTERING THE ACCURATE AND APPROPRIATE TPL INFORMATION IN THE CORRECT SEGMENT OF THE EDI TRANSACTION, INCLUDING THE REQUIRED LA ASSIGNED 6-DIGIT CARRIER CODE IN 2330B, NM109. PLEASE CONTACT YOUR SOFTWARE VENDOR TO ENSURE THAT YOU ARE ABLE TO SUBMIT THESE EDI CLAIMS. VENDORS SHOULD REFER TO THE EDI COMPANION GUIDE ON WWW.LAMEDICAID.COM AND CONTACT THE UNISYS EDI DEPARTMENT AT 225-216-6000 OPTION 2, TO TEST OR FOR ASSISTANCE WITH EDI TRANSMISSIONS.

ATTENTION TAKE CHARGE FAMILY PLANNING WAIVER PROVIDERS

IT IS THE INTENTION OF DHH TO ALSO INCORPORATE THE RECENT PROFESSIONAL FEE ADJUSTMENTS FOR PAYMENT OF SERVICES THROUGH THE TAKE CHARGE FAMILY PLANNING WAIVER PROGRAM. HOWEVER, THE ADJUSTMENTS RECENTLY MADE TO THE PROFESSIONAL FEE SCHEDULE HAVE NOT YET BEEN IMPLEMENTED FOR TAKE CHARGE SERVICES. ONCE THE FEE ADJUSTMENTS ARE MADE, PAID TAKE CHARGE SERVICE CLAIMS WILL BE RECYCLED TO PAY THE ADJUSTED RATES. WE WILL APPRECIATE YOUR CONTINUING TO PROVIDE THESE SERVICES AND BILLING THESE CLAIMS, AND THE RECYCLE WILL TAKE PLACE AS SOON AS THE FEES ARE UPDATED ON THE CLAIMS PROCESSING SYSTEM. THANK YOU FOR YOUR PATIENCE AND YOUR WILLINGNESS TO SERVICE OUR TAKE CHARGE RECIPIENTS.

ATTENTION MENTAL HEALTH REHABILITATION PROVIDERS

YOU MAY HAVE RECENTLY RECEIVED A LETTER FROM LA MEDICAID CONCERNING RECOUPMENT OF CLAIMS RELATED TO A MEDICARE RECOVERY PROJECT. PLEASE DISREGARD THESE LETTERS AS THEY WERE MAILED TO YOU IN ERROR. NO CLAIMS WERE RECOUPED AS A RESULT OF THIS ERROR. WE APOLOGIZE FOR ANY INCONVENIENCE THIS ERROR MAY HAVE CAUSED.

ATTENTION WAIVER PCS PROVIDERS

CLAIMS PROCESSED FOR LT-PCS SERVICES WITH UNITS OVER 32 AND FOR DATES OF SERVICES FROM OCTOBER 2007 AND FORWARD ARE BEING SYSTEMATICALLY ADJUSTED OR VOIDED TO BE IN COMPLIANCE WITH THE NEW POLICY CHANGES. CLAIMS WITH UNITS GREATER THAN 32 AND LESS THAN 47 WILL POST AN EOB OF 543 AND, IF APPLICABLE, WILL PAY ANY DIFFERENCE BETWEEN WHAT WAS ORIGINALLY PAID AND THE NEW AMOUNT. THOSE CLAIMS WITH UNITS OVER 47 WILL BE VOIDED AND YOU WILL HAVE TO RESUBMIT THOSE CLAIMS FOR CORRECT PAYMENT. PLEASE CONTACT SUSAN ROBINSON AT (225) 342-2778 IF FURTHER INFORMATION IS NEEDED.

ATTENTION PROFESSIONAL SERVICES PROVIDERS

PRENATAL VISITS: 2007 REIMBURSEMENT CHANGES AND ADJUSTMENTS AS PART OF THE REIMBURSEMENT CHANGES FUNDED IN THE 2007 LEGISLATIVE SESSION AND APPROVED BY CMS, EFFECTIVE WITH DATES OF SERVICE ON OR AFTER 10-15-07, THE SAME METHODOLOGY USED IN RATE CHANGES FOR THE OTHER SELECTED PHYSICIAN SERVICES HAS BEEN APPLIED TO PRENATAL OFFICE VISITS (VISITS MODIFIED WITH TH). SEE THE RA MESSAGE OF 3-18-08 FOR DETAILS OF THE METHODOLOGY USED. THE PROFESSIONAL SERVICES FEE SCHEDULE THAT INCLUDES THESE SERVICES CAN BE FOUND AT WWW.LAMEDICAID.COM. THOSE PRENATAL SERVICES IMPACTED BY THE RATE CHANGE EFFECTIVE WITH DATES OF SERVICE ON OR AFTER 10-15-07 ARE BEING SYSTEMATICALLY ADJUSTED. THE RECYCLE OF THESE CLAIMS WILL APPEAR ON THE RA OF 5-13-08.


ATTENTION DENTAL PROVIDERS

IF YOU DO NOT PROVIDE MEDICAID-COVERED SEDATION IN YOUR OFFICE, YOU MUST INFORM MEDICAID RECIPIENTS UPON EACH APPOINTMENT SCHEDULING THAT: 1) YOUR OFFICE DOES NOT PROVIDE THE TYPE OF SEDATION COVERED BY MEDICAID; 2) THE PATIENT WILL BE RESPONSIBLE FOR THE FULL PAYMENT OF NON-COVERED SEDATION/ANESTHESIA IF THE PATIENT CONTINUES TO SEEK THE NON-COVERED SERVICE; 3) ANOTHER DENTAL OFFICE CAN PROVIDE MEDICAID-COVERED SEDATION; AND 4) OTHER DENTAL OFFICE CONTACT INFORMATION MAY BE OBTAINED BY CALLING THE MEDICAID REFERRAL ASSISTANCE HOTLINE AT
1-877-455-9955. THE PATIENT'S RECORD MUST REFLECT THAT THE PATIENT WAS INFORMED OF THIS INFORMATION AND CHOSE TO UTILIZE THE SERVICES OF YOUR OFFICE, WHEN APPLICABLE.