RA Messages for September 09, 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 detailed FUL changes are posted on www.lamedicaid.com

PLEASE NOTE THE FOLLOWING CHANGES TO APPENDIX C:

LABELER                 COMPANY                                             BEG                     END
23110         PROBACTIVE BIOTEC, INC.                           10/01/08
24477         EKR THERAPEUTICS, INC.                             10/01/08
24486         ARISTOS PHARMACEUTICALS, INC.           10/01/08
25208         MEDICURE PHARMA. INC.                            10/01/08
59640         UNICO HOLDINGS, INC.                                                             04/01/08
64370         PIERRE FABRE MEDICAMENT                       10/01/08

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 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.

ATTENTION MHR AND HOME HEALTH PROVIDERS:

It has come to our attention that mental health rehab providers are "contracting" with home health providers to administer injections related to MHR services, and these home health claims are being denied by Medicaid. Medication management, which includes medication administration, is a mandatory service that must be rendered by all mental health rehab providers. This service may not be outsourced. It must be provided by the MHR provider. Home health claims for these services will continue to correctly deny if submitted for payment.

ATTENTION HOSPICE PROVIDERS

MSA CODE ASSIGNMENT FOR FY 2009 EFFECTIVE OCTOBER 1, 2008

RAPIDES 220                  BAYOU CANE 3350                NEW ORLEANS 5560                 CADDO 7680
DESOTO 7680                ALEXANDRIA 220                   TERREBONNE 3350                    ST. JAMES 5560
HOUMA 3350                 JEFFERSON 5560                     LIVINGSTON 760                       THIBODEAUX 3350
GRANT 220                    IBERVILLE 760                         LAFAYETTE 3880                        PLAQUEMINE 5560
POINTE COUPE 760     ST. MARTIN 3880                     ST. BERNARD 5560                     METAIRIE 5560
LAKE CHARLES 3960  ST. CHARLES 5560                   CALCASIEU 3960                        EBR 760
ST. TAMMANY 5560    ASCENSION 760                      MONROE 5200                             SHREVEPORT 7680
OUACHITA 5200           BOSSIER CITY 7680                WBR 760                                        UNION 5200
NON-URBAN 9919       ST. JOHN BPT 5560                  E. FELICIANA 760                        KENNER 5560
BATON ROUGE 760     ORLEANS 5560                         LAFOURCHE 3350                       ST. HELENA 760
CAMERON 3960           W. FELICIANA 760                   BOSSIER 7680