RA Messages for August 10, 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 FUL EFF
CLOBETASOL
PROP AERO FOAM,TOP 0.5% $2.97960 08/28/09
DESIPRAMINE
HCL TABLET 25MG OFF FUL 08/28/09
DESIPRAMINE
HCL TABLET 50MG OFF FUL 08/28/09
DESIPRAMINE
HCL TABLET 75MG OFF FUL 08/28/09
DESIPRAMINE
HCL TABLET 100MG OFF FUL 08/28/09
DESIPRAMINE
HCL TABLET 150MG OFF FUL 08/28/09
DESOGESTREL;ETHIN
EST. TABLET 0.15;0.03MG $1.09500 08/28/09
DIVALPROEX
SODIUM CAP.SPRINK 125MG $0.82100 08/28/09
HYDROCORTISONE
BUTYRATE SOLUTION,TOP 1% $0.37880 08/28/09
HYDROMORPHONE
HCL TABLET 2MG $0.21840 08/28/09
LAMOTRIGINE
TAB DISPER 5MG $0.66090 08/28/09
LAMOTRIGINE
TAB DISPER 25MG $0.69230 08/28/09
LAMOTRIGINE
TABLET 25MG $0.30350 08/28/09
LAMOTRIGINE
TABLET 100MG $0.34670 08/28/09
LAMOTRIGINE
TABLET 150MG $0.38000 08/28/09
LAMOTRIGINE
TABLET 200MG $0.41350 08/28/09
METOPROLOL
SUCCINATE TAB.SR 24H 100MG $1.42380 08/28/09
METOPROLOL
SUCCINATE TAB.SR 24H 200MG $2.26500 08/28/09
METRONIDAZOLE
LOTION 0.75% $1.16950 08/28/09
MYCOPHENOLATE
MOFETIL CAPSULE 250MG $0.52910 08/28/09
MYCOPHENOLATE
MOFETIL TABLET 500MG $1.05800 08/28/09
OMEPRAZOLE
CAPSULE DR 40MG $1.73430 08/28/09
RIFAMPIN
CAPSULE 150MG $1.47800 08/28/09
STAVUDINE
CAPSULE 15MG $2.25550 08/28/09
STAVUDINE
CAPSULE 20MG $2.34570 08/28/09
STAVUDINE
CAPSULE 30MG $2.49120 08/28/09
STAVUDINE
CAPSULE 40MG $2.68750 08/28/09
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.
POLICY UPDATE:
AMBULATORY SURGICAL CENTERS (NON-HOSPITAL)
REIMBURSEMENT FOR CORNEAL TISSUE
Effective with date of service September 1, 2008, in addition to the
facility fee for the surgery, Louisiana Medicaid will reimburse
the ASC for corneal tissue (currently HCPCS code V2785) used in corneal
transplant procedures. It is the Department's intent that corneal
tissue be reimbursed only when a valid facility fee for the related
surgical procedure has been paid to the ASC on the same date of service
for the same recipient. As in all circumstances, providers are
expected to maintain appropriate records documenting the services
billed to Medicaid.
Only those corneal tissue claims for date of service September 1, 2008
and after will be considered for this payment methodology. ASC providers
that performed corneal transplants and were paid the facility fee for
corneal transplant surgery may now submit claims for the corneal tissue,
if applicable, for DOS September 1, 2008 forward. However, to prevent
inadvertent denials in the future, the ASC should bill for both the surgery and
the corneal tissue on the same claim. The situation is an
exception to current published Non-Hospital ASC policy stating "There
should only be one line item per claim form."
ATTENTION PHYSICIANS
Due to a claims processing error, some duplicate Medicare Part B claims
were paid in the past. All duplicate claims paid 7/1/07 or after are
being voided on the 7/28/09 RA. We regret any inconvenience this
processing error may have caused. Please contact Unisys Provider
Relations if you have any questions.
ATTENTION DENTAL PROVIDERS
Louisiana Medicaid enrolled dental providers are required to update
their provider contact information through the www.lamedicaid.com
website. The Provider Locator Information link allows providers to
update existing contact information and the option to indicate if
they are "Accepting New Medicaid Patients," which will then be viewable
to the public when using the Provider Locator Tool to locate Medicaid
providers. Complete details are located on the www.lamedicaid.com
website. Questions about the website may be directed to
Unisys Provider Relations at (800) 473-2783 or (225) 924-5040.
ATTENTION PROFESSIONAL SERVICES PROVIDERS
COCHLEAR IMPLANT POST-OPERATIVE PROGRAMMING CODES
Effective with date of service July 1, 2006 forward, Louisiana Medicaid
reimburses for cochlear implant post-operative programming codes
(current CPT code range 92601-92604). Providers are to adhere to
national standards and CPT guidelines when billing for these services.
If nationally approved changes occur to these CPT codes at a future
date, providers are to follow the most accurate coding available for
covered services for that particular date of service, unless otherwise
directed. Medicaid payments received by providers for inappropriate
services are subject to review, recoupment and sanction. A systematic
recycle of claims that originally denied for "procedure/type of service
not covered by program" will be completed in the near future. No action
is necessary by providers. Notification will be made via remittance
advice message when the recycle occurs.
ATTENTION
PROVIDERS OF TAKE CHARGE FAMILY PLANNING WAIVER SERVICES
The TAKE
CHARGE Program is limited to coverage of family planning services ONLY,
and only those services are approved and payable. The approved list of
diagnosis codes is available in the documentation for this program
online at www.takecharge.dhh.louisiana.gov, and the family planning
diagnosis MUST be the primary diagnosis on any claim for TAKE CHARGE
recipients. This supports the fact that you are seeing the patient for
family planning services and billing Medicaid for those services. If
reporting other diagnoses on the claim is appropriate, they should be
reported as additional diagnoses. Also, please remember, if services
other than the covered family planning services are in order, the
recipient should be informed prior to the visit/prior to providing the
services that such services are not covered through the TAKE CHARGE
Program.