RA Messages for May 12, 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 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.

ATTENTION PROVIDERS: EFFECTIVE WITH PROCESSING DATE MAY 23, 2008

(RA DATE 5/27/08) FOR DATES OF SERVICE MARCH 1, 2008 AND AFTER, OUT PATIENT HOSPITAL CLAIMS AND LICENSED HEMODIALYSIS CENTER CLAIMS ARE REQUIRED TO SUBMIT NDC INFORMATION AND THE CORRESPONDING HCPCS CODE FOR PHYSICIAN-ADMINISTERED DRUGS ON THE 837I (INSTITUTIONAL TRANSACTION) AND THE UB-04 CLAIM FORM. UPDATED BILLING INSTRUCTIONS FOR THE UB-04 FORM ARE NOW LOCATED ON THE LA MEDICAID WEBSITE UNDER BILLING INFORMATION AND NEW MEDICAID INFORMATION LINKS. UPDATED BILLING INSTRUCTIONS FOR LICENSED HEMODIALYSIS CENTERS ARE FORTHCOMING. PLEASE MONITOR RA MESSAGES AND THE WEBSITE TO LEARN WHEN THESE INSTRUCTIONS BECOME AVAILABLE. THE REVISED EDI COMPANION GUIDE FOR THE 837I IS AVAILABLE ONLINE. THE NDC INFORMATION MUST BE ENTERED ON THE CLAIM SUBMISSION EXACTLY AS INDICATED IN THE BILLING INSTRUCTIONS TO PREVENT FUTURE CLAIM DENIALS. EFFECTIVE WITH DATE OF PROCESSING JULY 1, 2008, CLAIMS THAT DO NOT CONTAIN THE REQUIRED, ACCURATE NDC INFORMATION SUBMITTED WILL DENY.

ATTENTION KIDMED CLINICS AND SCHOOL BASED HEALTH CENTERS

WE ARE PLEASED TO ANNOUNCE THAT ALL PROVIDERS OF KIDMED SERVICES, INCLUDING KIDMED CLINICS AND SCHOOL BASED HEALTH CENTERS, MAY NOW ACCESS THEIR RS-0-07 REPORTS ELECTRONICALLY ON THE SECURE SIDE OF THE LA MEDICAID WEB SITE, WWW.LAMEDICAID.COM, UNDER ->COMMUNITYCARE AND/OR KIDMED ROSTER OF ENROLLEES. THESE REPORTS ARE LOADED TO THE WEB SITE MONTHLY AND REMAIN ON THE SITE FOR 2 MONTHS TO ALLOW YOU TO ACCESS THE CURRENT AND THE PREVIOUS MONTHS' REPORTS. THE REPORTS ARE ALSO DOWNLOADABLE TO ALLOW YOU TO SAVE THEM IF YOU NEED TO MAINTAIN MORE THAN THE MOST RECENT 2 MONTHS OF DATA. EFFECTIVE JULY 1, 2008, HARD COPY REPORTS WILL NO LONGER BE MAILED TO YOU, AND REQUESTS FOR REPORTS TO BE REPRINTED HARD COPY WILL NOT BE HONORED. PLEASE ENSURE THAT YOU HAVE PROCEDURES IN PLACE TO RETRIEVE THESE REPORTS AS NEEDED.