RA Messages for June 30, 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.

Please note the following changes to Appendix A

     DRUG                 DOSE      STRG     LMAC         FUL       EFF 

 ATENOLOL                TABLET      25MG                $0.04590 7/17/09

 ATENOLOL                TABLET      50MG                $0.05000 7/17/09

 ATENOLOL                TABLET     100MG                $0.06900 7/17/09

 CEFADROXIL HYDRATE      CAPSULE    500MG                $0.78300 7/17/09

 CLINDAMYCIN HCL         CAPSULE    150MG                $0.21530 7/17/09

 CLINDAMYCIN HCL         CAPSULE    300MG                $1.19750 7/17/09

 DICYCLOMINE HCL         CAPSULE     10MG                $0.08850 7/17/09

 DICYCLOMINE HCL         CAPSULE     20MG                $0.04050 7/17/09

 GABAPENTIN              TABLET     600MG                $0.97380 7/17/09

 GABAPENTIN              TABLET     800MG                $1.17560 7/17/09

 GEMFIBROZIL             TABLET     600MG                $0.13500 7/17/09

 HALOBETASOL PROPIONATE  TOP CR     0.05%                $0.48000 7/17/09

 HALOBETASOL PROPIONATE  TOP OINT   0.05%                $0.53250 7/17/09

 HYDROXYCHLOROQUINE SULF TABLET     200MG                $0.22500 7/17/09

 LISINOPRIL/HCTZ         TABLET  10MG/12.5MG             $0.20970 7/17/09

 LISINOPRIL/HCTZ         TABLET  20MG/12.5MG             $0.21990 7/17/09

 LISINOPRIL/HCTZ         TABLET  20MG/25MG               $0.22250 7/17/09

 MECLIZINE               TABLET      25MG                 OFF FUL 7/17/09

 METFORMIN HCL           TABLET ER  500MG                $0.13070 7/17/09

 METFORMIN HCL           TABLET ER  750MG                $0.33680 7/17/09

 PENTAZOCINE/NALOX. HCL  TABLET  50MG/0.5 MG   $1.30040           5/21/09

 POTASSIUM CHLORIDE      CAPSULE    10MEq      $0.79460           6/16/09

 PRAVASTATIN SODIUM      TABLET      10MG                $0.25000 7/17/09

 PRAVASTATIN SODIUM      TABLET      20MG                $0.29170 7/17/09

 PRAVASTATIN SODIUM      TABLET      40MG                $0.35600 7/17/09

 PROPRANOLOL HCL         TABLET      60MG                $1.27920 7/17/09

 TOPIRAMATE              TABLET      25MG                $0.24200 7/17/09

 TOPIRAMATE              TABLET      50MG                $0.48150 7/17/09

 TOPIRAMATE              TABLET     100MG                $0.65930 7/17/09

 TOPIRAMATE              TABLET     200MG                $0.77180 7/17/09

 

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

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 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.

ATTENTION HOME HEALTH PROVIDERS

Claims that inappropriately denied for errors 191 (PROCEDURE REQUIRES PRIOR AUTHORIZATION) and 233 (PROCEDURE/NDC NOT COVERED FOR SERVICE DATE GIVEN) since the 5/26/09 RA are being systematically recycled for correct processing. In addition, any claims paid during this same time frame that paid incorrectly are being adjusted for correct payment. These claims should appear on the RA of 06/23/09. No provider action is necessary.

RHC/FQHC PROVIDERS 2008 MEI RATE ADJUSTMENT

Only July 1, 2008, a number of RHC and FQHC providers Prospective Payment System rates were erroneously adjusted, resulting in incorrect payments for services rendered from July 1 through July 31, 2008. In August 2008, providers were notified and informed any claims with dates of service during this time frame would be recycled for proper reimbursement.
 
All RHC/FQHC providers rates impacted by error will receive payment on their June 23rd, 2009 Remittance Advice.
 

ATTENTION DENTAL PROVIDERS
CLAIMS FOR D7120-D7250 THAT DENIED FOR ERROR 779

EPSDT Dental claims that were submitted for dental procedure codes D7120-D7250 that were erroneously denied with edit 779 (PROCEDURE ON EXTRACTED TOOTH NOT PAYABLE) are being systematically recycled for correct processing. These claims should appear on the RA of June 23, 2009. Should you have any questions, you may contact Unisys Provider Relations by calling (800) 473-2783 or (225) 924-5040.
 


ATTENTION: PROVIDERS OF NEONATAL INTENSIVE CARE SERVICES

Providers may have experienced inadvertent denials on CPT codes 99478 (Subsequent intensive care... less than 1500 grams), 99479 (Subsequent intensive care... body weight of 1500-2500 grams), and 99480 (Subsequent intensive care... body weight of 2501-5000 grams) for error 234 (age restriction) on the RA's of June 9 and June 16, 2009. The system logic has been corrected. Those claims that should not have received this denial will be systematically adjusted and it is anti-cipated the adjustments will be seen on the RA of June 23, 2009. No action need be taken by providers.
 


IMPORTANT COMMUNITYCARE UPDATE
FOR PROVIDERS SUBMITTING CLAIMS USING THE 837I TRANSACTION

The 837I Companion Guide specifications have been revised to remove the Other Provider Specialty Loop which does not allow the transmission of taxonomy codes for CommunityCARE PCP referral authorization numbers for LA Medicaid claims. Please visit the LA Medicaid website, www.lamedicaid.com, on the homepage link, NPI CC Referral Authorization Number Changes, for the recently posted provider notice concerning changes in the instructions for transmitting this data in the 837I transaction.
 


ATTENTION NOW WAIVER PROVIDERS

Recently, a new category of funding was implemented for NOW recipients. Some claims for these recipients were paid to you through the wrong funding category. Because it is necessary to have these payments reported correctly by DHH, we are voiding the affected claims on this week's RA (6/23/09) and reprocessing them on a mid-week RA of 6/24/09. No action is required by providers. We apologize for this inconvenience and appreciate your patience as we correct this payment issue.
 


ATTENTION DENTAL PROVIDERS - EPSDT DENTAL REIMBURSEMENT INCREASE

On the 6/16/09 RA, Louisiana Medicaid recycled claims for dates of service from December 24, 2008, until the present for services related to the EPSDT Dental reimbursement increase and program policy changes. Claims that denied for edit 232 (Procedure Not Covered by Program) were also recycled. Recycled claims appeared as adjustments and voids for those providers that billed their usual and customary fees. Should you have any questions, you may contact Unisys Provider Relations by calling (800) 473-2783 or (225) 924-5040.