RA Messages for June 24, 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

HEPARIN SODIUM, BEEF                           VIAL                         1000 U/ML             OFF MAC         03/01/08
HEPARIN SODIUM, BEEF                           VIAL                         10000 U/ML           OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   DISP SYR                 10 U/ML                 OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   DISP SYR                 100 U/ML               OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   DISP SYR                 10000 U/ML           OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   DISP SYR                 20000 U/ML           OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   DISP SYR                 5000 U/ML             OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   VIAL                         10 U/ML                 OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   VIAL                         100 U/ML               OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   VIAL                         1000 U/ML             OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   VIAL                         10000 U/ML           OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   VIAL                         20000 U/ML           OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE                   VIAL                         5000 U/ML             OFF MAC         03/01/08
HEPARIN SODIUM, PORC/5% DEXT        IV SOL                      100 U/ML               OFF MAC         03/01/08
HEPARIN SODIUM, PORC/5% DEXT        IV SOL                      25000 U/ML           OFF MAC         03/01/08
HEPARIN SODIUM, PORC/5% DEXT        IV SOL                      25000 U/ML           OFF MAC         03/01/08
HEPARIN SODIUM, PORC/0.9% NACL    IV SOL                       2 U/ML                  OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE/PF             DISP SYR                  10 U/ML                 OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE/PF             DISP SYR                  100 U/ML               OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE/PF             VIAL                          10 U/ML                 OFF MAC         03/01/08
HEPARIN SODIUM, PORCINE/PF             VIAL                          1000 U/ML             OFF MAC         03/01/08

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

ATTENTION PHARMACY PROVIDERS

Please be advised that certain pharmacy claims billed to Medicare part b which crossed over to Medicaid and denied have been recycled for Medicaid payment. These claims were billed with procedure codes recently updated by Medicare. The Medicaid system has now been adjusted to accept these codes. Any questions regarding these claims should be directed to the Unisys Point of Sale helpdesk at (225) 216-6381 or 1-800-648-0790.

ATTENTION DENTAL PROVIDERS

The dental claims adjustment and recycle related the dental rate increases that were effective 11-01-07 will appear on your remittance advice in the near future. Providers who bill their usual and customary fee as required by Medicaid should receive payment adjustments without taking further action. You may go to www.lamedicaid.com for further details. Contact LSU Dental Medicaid unit at 504-941-8206 or 1-866-263-6534 (toll-free) if you have any questions.

ADJUSTMENT OF CIRCUMCISION CLAIMS

System changes have been made to correct age editing associated with CPT code 54150 for circumcisions. Claims that incorrectly denied for age restriction (error 234) beginning with DOS 01-01-07 have been systematically adjusted which are included in the 06-24-08 remittance. For further questions, contact Unisys Provider Relations at 1-800-473-2783.

PREVENTIVE MEDICINE/KIDMED REIMBURSEMENT

Reimbursement rates for preventive medicine services, including KIDMED medical screenings, have been increased effective with date of service October 15, 2007, as part of the 2007 reimbursement changes and a system adjustment appears on the RA dated June 17, 2008. If your claims for these services do not appear in the RA dated June 17, 2008, then your billed charges were less than or equal to the fee on file prior to the rate increase. Claims where billed charges were less than or equal to the fee on file will not have systematic adjustments. For proper claim adjustment policy and procedures, providers should review the '2007 KIDMED provider training manual,' pages 30, 38, and/or 64, or the '2007 professional services provider training manual,' pages 121 or 128, as appropriate. DHH policy states providers are to enter their usual and customary charges for services rendered. Contact Unisys provider relations at (800) 473-2783 with any questions.

COMMUNITYCARE POLICY REVISION

CC policy requires post-authorization from the PCP for the two lowest levels of emergency room (CPT codes 99281 and 99282) and associated services. Currently, requests for post authorization must be submitted to the PCP, along with documentation of presenting symptoms, the next business day following date of service. Effective for date of service 07-01-2008, the time frame for submitting requesting for post-authorization of ER visits has been extended to 10 calendar days following DOS. For questions about CC policy, call Unisys provider relations at (800)473-2783, or cc hotline (800)259-4444.