RA Messages for September 8, 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       STRGTH      MAC         EFF  

 AMIODARONE HCL               TABLET       200MG     $0.73750    09/25/09

 AMOX TR/POTASSIUM CLAVULAN   ORAL SUSP   600MG/5ML  $0.45000    09/25/09

 AMOX TR/POTASSIUM CLAVULAN   TABLET        500MG    $2.11580    09/25/09

 AMOX TR/POTASSIUM CLAVULAN   TABLET        875MG    $2.53200    09/25/09

 CLOBETASOL PROPIONATE        TOP CREAM    0.05%     $0.44650    09/25/09

 CLOTRIMAZOLE/BETAMET DIPROP  TOP CREAM   1%/0.05%   $0.82300    09/25/09

 CITALOPRAM HYDROBROMIDE      SOLUTION      10MG     $0.31240    09/25/09

 CITALOPRAM HYDROBROMIDE      TABLET        10MG     $0.16730    09/25/09

 CITALOPRAM HYDROBROMIDE      TABLET        20MG     $0.17250    09/25/09

 CITALOPRAM HYDROBROMIDE      TABLET        40MG     $0.17550    09/25/09

 CLARITHROMYCIN               TABLET       500MG     $0.86250    09/25/09

 CLOBETASOL PROPIONATE        TOP CREAM    0.05%     $0.18250    09/25/09

 ERYTHROMYCIN                 OPH OINT     0.5%      $1.50286    09/25/09

 METHYLPHENIDATE HCL          TABLET         5MG     $0.22530    09/25/09

 METHYLPHENIDATE HCL          TABLET        10MG     $0.30060    09/25/09

 METHYLPHENIDATE HCL          TABLET        20MG     $0.33090    09/25/09

 METOPROLOL SUCCINATE         TABLET SR    100MG     OFF MAC     09/25/09

 METOPROLOL SUCCINATE         TABLET SR    200MG     OFF MAC     09/25/09

 NAPROXEN                     TABLET       250MG     $0.10320    09/25/09

 NAPROXEN                     TABLET       375MG     $0.07610    09/25/09

 NAPROXEN                     TABLET       500MG     $0.08240    09/25/09

 OFLOXACIN                    OPH DROPS     0.3%     $3.45000    09/25/09

 TIZANIDINE HCL               TABLET         2MG     $0.26000    09/25/09

 TIZANIDINE HCL               TABLET         4MG     $0.32000    09/25/09

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 HOSPITAL PROVIDERS

Review of claims related to the NDC implementation has revealed that some providers are submitting NDC data with inappropriate revenue codes.Effective August 31, 2009, for the RA of September 8, 2009, a new edit will be implemented to deny outpatient hospital claim lines when NDC data is reported with a revenue code that is not in the 250-259 or 630-639 range. The new edit is 545, Revenue Code Invalid for Reporting NDC Info. Hospital providers must ensure that NDC data is reported with correct revenue codes in order to eliminate unnecessary denials.

ATTENTION FREE-STANDING ESRD FACILITIES
SYSTEMATIC CLAIMS ADJUSTMENT

A systematic adjustment of Free-Standing ESRD Facility claims will occur on the RA of August 25, 2009, for claims that were paid incorrectly as a result of the delay in implementation and/or a programmatic error in payment calculation when the rate reductions were implemented for dates of service on or after February 26, 2009. These reductions were part of the 2009 Medicaid budget cuts. No action is necessary by providers. A minor increase or decrease in payments will be noted as a result of these adjustments.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
INTRAVASCULAR STENTS: DIAGNOSIS EDIT RESTRICTION DISCONTINUED

Effective with date of service 7/1/07 forward, diagnosis edit restrictions for transcatheter placement of intravascular stents (current CPT codes 37205-37208) have been discontinued. These CPT codes are no longer limited to the primary or secondary diagnosis codes 440.21, 440.22, 444.81, or 572.3. Providers can now resubmit claims that previously denied for edit 251 (Denied Due to Diagnosis). The Department will approve timely filing overrides for claims that denied for these diagnosis restrictions as long as they were originally submitted within the 1-year filing limit. Claims over the 1-year filing limit may be submitted through normal channels with the RA page indicating proof of timely filing attached. Claims over the 2-year filing limit should be submitted to Unisys Provider Relations with the RA indicating proof of the 1-year filing limit and a letter requesting that the claim(s) be overridden for the 2-year limit and reprocessed for payment.

ALERT TO PHARMACY POS PROVIDERS

The LA Medicaid POS system will be unavailable on Sunday, September 13, 2009, beginning at approximately 2 p.m. and continuing for 6-8 hours due to extended maintenance. The MEVS and REVS eligibility systems will not be affected by this maintenance window. Providers may verify recipient eligibility through MEVS/REVS during this period while the system is unavailable.

ATTENTION NEW OPPORTUNITIES WAIVER (NOW) AND TARGETED SUPPORT
COORDINATION (NFP, VACP, HIV) MEDICAID PROVIDERS

To avoid a budget deficit, rate reductions were implemented for certain services in the Medicaid Program. Unfortunately, some procedure codes were updated after the effective date of those reductions, causing some claims to be paid at an incorrect higher rate. Claims are recycled in this checkwrite (claims identified with EOB code 570).

ATTENTION NEW OPPORTUNITIES WAIVER (NOW) AND LONG TERM PERSONAL
CARE SERVICE (LT-PCS) MEDICAID PROVIDERS

To avoid a budget deficit, effective with date of service February 1, 2009, rate reductions were implemented for certain services in the waivers and long term personal care programs. Unfortunately, some procedure codes were inadvertently excluded from the reductions, causing some claims to be paid at an incorrect higher rate. File updates have been completed and claims are recycled in this checkwrite (claims identified with EOB code 570).