RA Messages for June 16, 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

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 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

Updates to the Pharmacy Benefits Management Services Manual are now available on the Louisiana Medicaid website at www.lamedicaid.com. Pharmacy providers should refer to the manual for a complete description of Medicaid pharmacy program policy.

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.

ATTENTION SUPPORTS WAIVER AND ELDERLY
AND DISABLED (EDA) MEDICAID PROVIDERS

To avoid a budget deficit, rate reductions were implemented for certain services in the Medicaid Program. Unfortunately, some support coordination procedure codes were inadvertently included in those reductions, causing some claims to be paid at an incorrect lower rate. File updates have been completed and claims are recycled on the RA of 6/16/09. These recycled claims are identified with EOB code 570.

FEE SCHEDULE UPDATE: 'PROFESSIONAL SERVICES, LAB, X-RAY, AND ASC'

Louisiana Medicaid has begun an update to the procedure file beginning with select CPT codes from the 'Urinary System,' 'Male Genital System,' 'Female Genital System,' and 'Cytopathology' sections of the CPT manual. The updates affected age, sex, and global surgery period indicators. Revisions of this nature should not adversely impact correctly submitted claims by providers. We anticipate that these updates will be reflected on the published fee schedule beginning July 2009.

ATTENTION DENTAL PROVIDERS

Reimbursement and program changes are implemented in the Extended Dental Services for Pregnant Women's dental program, as well as the addition of a new dental procedure code to the EPSDT dental program. Complete details can be located on the www.lamedicaid.com website under the 'Billing Information' and 'Fee Schedule' links. Contact the LSU Dental Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free) with any questions.

IMPORTANT INFORMATION RELATED TO PROVIDING SERVICES TO TAKE CHARGE
WAIVER RECIPIENTS
ATTENTION ALL PROVIDERS

DHH is receiving many, many calls from recipients enrolled in the TAKE CHARGE Family Planning Waiver Program regarding bills they have received on denied services. Many of the denials are because a provider used an incorrect (non-covered) procedure/diagnosis code on the claim. Other denials are because providers did not check eligibility to determine that the recipient has limited coverage through TAKE CHARGE, and/or medical charts are not flagged to indicate that the patient is a TAKE CHARGE recipient. This recipient population has limited coverage and providers can refer to the LA Medicaid website at www.lamedicaid.com to verify covered services with their respective billable codes.