RA Messages for August 26, 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
FUL
EFF
ALENDRONATE
TABLET
35MG
15.36750 08/20/08
ALENDRONATE
TABLET
70MG
15.36750 08/20/08
BALSALAZIDE DISODIUM
CAPSULE
750MG
1.07960 08/20/08
BENZONATATE
CAPSULE
200MG
0.63380 08/20/08
BUPROPION HCL
TABLET SA
150MG
1.83300 08/20/08
CARVEDILOL
TABLET
3.125MG
0.14250 08/20/08
CARVEDILOL
TABLET
6.25MG
0.14250 08/20/08
CARVEDILOL
TABLET
12.5MG
0.14250 08/20/08
CARVEDILOL
TABLET
25MG
0.14250 08/20/08
DICLOFENAC SODIUM
DROPS
0.1%
4.27200 08/20/08
ONDANSETRON HCL
TABLET
4MG
1.10000 08/20/08
ONDANSETRON HCL
TABLET
8MG
1.90000 08/20/08
OXYCODONE HCL
TAB SR. 12H
10MG
OFF MAC 08/08/08
OXYCODONE HCL
TAB SR. 12H
20MG
OFF MAC 08/08/08
OXYCODONE HCL
TAB SR. 12H
40MG
OFF MAC 08/08/08
OXYCODONE HCL
TAB SR. 12H
80MG
OFF MAC 08/08/08
PRAVASTATIN SODIUM
TABLET
80MG
OFF MAC 08/20/08
PREDNISOLONE SOD PHOSPHATE SOLUTION
15MG/5ML 0.20890
08/20/08
PROPRANOLOL HCL
CAP.SA 24H
80MG
1.54470 08/20/08
PROPRANOLOL HCL
CAP.SA 24H
120MG
1.91600 08/20/08
PROPRANOLOL HCL
CAP.SA 24H
160MG
2.50880 08/20/08
RANITIDINE HCL
SYRUP
15MG/ML
0.40270 08/20/08
ROPINIROLE HCL
TABLET
1MG
0.75150 08/20/08
ROPINIROLE HCL
TABLET
2MG
0.75150 08/20/08
ROPINIROLE HCL
TABLET
3MG
0.77960 08/20/08
ROPINIROLE HCL
TABLET
4MG
0.77960 08/20/08
SERTALINE HCL
TABLET
25MG
0.12830 08/20/08
SERTALINE HCL
TABLET
50MG
0.12830 08/20/08
SERTALINE HCL
TABLET
100MG
0.12830 08/20/08
TRANDOLAPRIL
TABLET
1MG
0.66660 08/20/08
TRANDOLAPRIL
TABLET
2MG
0.66660 08/20/08
TRANDOLAPRIL
TABLET
4MG
0.66660 08/20/08
ZALEPLON
CAPSULE
5MG
0.71910 08/20/08
ZALEPLON
CAPSULE
10MG
0.73860 08/20/08
ZOLPIDEM TARTRATE
TABLET
5MG
0.07040 08/20/08
ZOLPIDEM TARTRATE
TABLET
10MG
0.07040 08/20/08
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 A, available at
www.lamedicaid.com.
ATTENTION OUTPATIENT HOSPITAL
PROVIDERS
Take charge Louisiana family planning waiver
program Louisiana Medicaid has updated and corrected the reimbursement policy
that applies to take charge family planning waiver participants for outpatient
ambulatory surgery hospital billing (revenue code 490). Claims submitted prior
to the correction of the system logic for take charge were paid billed charges
instead of the appropriate rate for the procedure or may have received an
inappropriate denial. The outpatient hospital ambulatory surgery claims (revenue
code 490) submitted for participants in the take charge program will be
recycled.
Please note that the only codes payable in combination with hr 490 (outpatient
ambulatory surgery) for take charge participants are 58301, 58600, 58615, 58670,
58671. Any HCPCS other than these will deny when billed in combination with hr
490.
ATTENTION PROFESSIONAL, DME,
HOSPITALS:
La Medicaid now accepts electronic transmission
of TPL claims that must be submitted for payment. Providers must submit these
claims using the correct 837 transaction. Providers are responsible for entering
all required, appropriate and accurate information from the primary carrier EOB
in the correct loops/ segments of the transaction. The correct 6-digit TPL
carrier code is also required. Providers should notify and coordinate with their
vendors if necessary to allow transmission of this additional information in the
claims transactions. Providers/ vendors should use the 837 national
specifications in conjunction with the la Medicaid EDI companion guide(s) to
ensure that all information is entered correctly. This change will allow more
efficient processing and payment of TPL claims. Please contact the Unisys EDI
department (225-216-6303) to test claim files or for other EDI-related
assistance. At a future date to be determined by DHH, TPL claims submitted hard
copy that are not accompanied by a true and complete EOB from the primary
carrier will be rejected. In the future, other providers will be allowed to bill
these claims electronically.