RA Messages for July 15, 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 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.

                                                                   ATTENTION PROFESSIONAL SERVICES PROVIDERS: 2008 RATE CHANGES

Based on funding appropriated in the 2007 legislative session and approval by CMS, effective with DOS on or after January 1, 2008, reimbursement rate changes for selected physician services have been implemented on our pricing file. The first remittance on which providers may see the new rates applied to claims is June 30, 2008. Please monitor the Medicaid website and RA messages in the near future for more general information, updated fee schedules, and information on systematic adjustments of claims paid at the previous rate.      

ATTENTION KIDMED CLINICS AND SCHOOL BASED HEALTH CENTERS

We are pleased to announce that all providers of KIDMED services, including KIDMED clinics and school based health centers, may now access their RS-0-07 reports electronically on the secure side of the LA Medicaid website, www.lamedicaid.com, link -> CommunityCare and/or KIDMED roster of enrollees. These reports are loaded to the web site monthly and remain on the site for 2 months to allow providers to access the current and the previous months' reports. The reports are also downloadable to allow providers to save them in your office system if you have a need to maintain more than the most recent 2 months of data. Effective 07-01-08, hard copy reports will no longer be mailed to you, and requests for reports to be reprinted hard copy will not be honored. Please ensure that you have procedures in place to retrieve these reports as needed.                

DELAY OF DENIAL EDITS FOR NDC ON PHYSICIAN ADMINISTERED DRUGS

Initially, with date of processing July 1, 2008, claims submitted without the required, accurate NDC information for Physician Administered Drugs were to deny. Currently, providers are receiving educational edits for claims that do not contain this information. The department has received concerns and issues from large providers experiencing difficulty in preparing their systems to submit these claims with the required information. As a result, the decision has been to delay the implementation of denials for the NDC educational edits until further notice. Please monitor the website and RA messages for updated info.