RA Messages for July 08, 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.

ATTENTION PHARMACISTS

 The university of Louisiana at Monroe (ULM), pharmacy prior authorization office is moving during the weekend of July 18. They will resume business on Monday, July 21, 2008. During this time, the prior authorization edits of 485 and 486 will be educational only.

PROFESSIONAL SERVICES AND RHC/FQHC PROVIDERS
ADJUNCT SERVICES

Effective with dos 10-21-07, Louisiana Medicaid reimburses for select adjunct services (currently CPT codes 99050-99051). Providers are responsible for adherence to the 'adjunct services policy,' which is located on www.lamedicaid.com under 'New Medicaid information' as well as in the 'Louisiana provider update.' professional services providers may now submit claims for these services.

rhc/fqhc providers may begin submitting claims to preserve timely filing, but should initially expect denials until programming is finished. RHC/FQHC claims that deny due to this issue will be systematically adjusted once programming is complete, and providers should monitor future RA's for further information.

ATTENTION PROVIDERS OF NEWBORN CARE: CPT CODE 99436

CPT code 99436, "attendance at delivery... Stabilization of newborn," Has been made payable effective with dos 06-01-08. Any policies directing providers to use other CPT codes for this service are no longer in effect. Providers are to follow CPT guidelines regarding which services may or may not be reported in addition to this code.