RA Messages for June 8, 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.

Detailed FUL changes are posted on www.lamedicaid. com

ATTENTION PHARMACISTS AND PHYSICIANS

Effective June 17, 2009, edits will be placed on Suboxone and Subutex prescriptions. The physician must FAX a copy of his/her current Controlled Substance Registration Certificate indicating the XDEA number and updated Provider Enrollment information to 1-225-216-6392. Prescriptions require a diagnosis code of opioid dependence. Maximum daily dose of Suboxone is 24mg and Subutex is 16mg/day. Only original prescriptions will be reimbursed. Concurrent prescriptions of other opioid analgesics and/or benzodiazepines from other prescribers will deny.

ATTENTION PHARMACY PROVIDERS

The Drug File used in claims processing is being phased to First Data Bank's Standard Format. The first phase of conversion will take place on Sunday, June 14. With this conversion, there are a few drugs which will have billing unit type changes. These drugs include Sumatriptan Succinate and Lucentis. Please visit www.lamedicaid.com or contact the POS Help Desk for specific billing unit type changes.

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 PATHOLOGY SERVICES PROVIDERS

Louisiana Medicaid was made aware of system issues with the processing of claims for CPT codes 88187 (Flow cytometry, interpretation; 2 to 8 markers), 88188 (Flow cytometry, ...9 to 15 markers), and 88189 (Flow cytometry, ...16 or more markers). Changes have been made to allow these claims to properly process. Claims that improperly denied for these services have been identified and recycled. The recycled claims are scheduled to appear on the R/A of June 8, 2009, and include dates of service beginning with January 1, 2005. No action is required by providers.

ATTENTION PROVIDERS: CLAIMS WITH
PLACE OF SERVICE 15 (MOBILE UNIT) OR 20 (URGENT CARE FACILITY)

Claims submitted with Place of Service 15 or 20 with Dates of Service on or after 9/1/2007 that were erroneously denied for Error 084 (Invalid Place of Treatment) are being systematically recycled for correct processing. These claims should appear on the RA of June 8, 2009. No action is required by providers.