RA Messages for September 22, 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 NEW
OPPORTUNITIES WAIVER (NOW) AND TARGETED SUPPORT
COORDINATION (NFP, VACP, HIV) MEDICAID PROVIDERS
**The following message appeared on
the RA of 9/8/09. A processing error occurred when these claims were
recycled and all claims denied with edit 799. These claims are correctly
adjusted on this RA (9/15/09). Please disregard the 799 denials and we
apologize for any inconvenience caused due to the incorrect claim
denials.**
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
**The following message appeared on
the RA of 9/8/09. A processing error occurred when these claims were
recycled and all claims denied with edit 799. These claims are correctly
adjusted on this RA (9/15/09). Please disregard the 799 denials and we
apologize for any inconvenience caused due to the incorrect claim
denials.**
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).
ATTENTION RHC/FQHC
COMMUNITYCARE PCPS
Claims
for the August monthly CommunityCARE Management Fees that denied with
error 233 (Procedure Not covered) are being systematically recycled. You
will see the correct processing/payment of these claims on the 09/22/09
RA. No provider action is required.
ATTENTION
PROVIDERS BILLING ELECTRONIC (EDI) CLAIMS
An EDI
processing error occurred the week of 09/07/09 that caused some EDI
claim files to be dropped from the system. Claims contained on these
dropped files were not processed in the checkwrite of 09/15/09. We have
retrieved the dropped files and they are being processed in this week's
RA (09/22/09). We have received calls from some providers and vendors
this week concerning their claim files, and in some cases the files were
resubmitted either by the provider/vendor or by Unisys EDI. If your
files were resubmitted, you may see duplicate claims on the 09/22/09 RA
where these files are being retrieved and reprocessed as a part of this
corrective action. Please disregard the duplicate denials, and we
apologize for any inconvenience this has caused our providers and
vendors. Please contact the Unisys EDI Department at 225-216-6303 if you
have concerns once this corrective action is taken.
ATTENTION
PROVIDERS
The DHH
has designated the Louisiana Health Care Quality Forum (LHCQF) as the
entity responsible for guiding Louisiana's efforts to secure funding and
support for health information technology through the stimulus bill.
Funding is available to support health care providers through technical
assistance and loan programs to assist in financing HIT acquisitions.
Additionally, providers can receive Medicare or Medicaid incentives if
they meet the "meaningful use" criteria that will be determined this
year.
The LHCQF is conducting a survey to gather necessary information to
inform all of its activities related to supporting providers in
Louisiana in meeting the incentive requirements and avoiding penalties
for not doing so. The current survey is for ambulatory health care
facilities.
Please
take a few minutes to complete the survey by using the following link:
http://www.surveymonkey.com/s.aspx?sm=X49GAwqaLbHIuGK_2bkOZKJQ_3d_3d.
The link may also be found on the LHCQF website at www.lhcqf.org. If you
do not have internet access but would like to complete the survey,
please call (225)334-9299.
Responses are needed by Friday, September 25, 2009.
ATTENTION
PROFESSIONAL PROVIDERS OF VACCINATIONS
Due to
the continued public health issues related to influenza, the Department
of Health and Hospitals (DHH) has received many calls regarding the
availability of seasonal influenza vaccines for Medicaid children. We
have republished the policy related to the vaccine and its
administration on the homepage of the lamedicaid.com website for your
review and use. After reviewing the policy, if you have questions,
contact DHH, the Office of Public Health (OPH) Vaccines for Children (VFC)
Program, your local health unit, or Unisys Provider Relations as
appropriate.