IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT THE PBM HELP DESK AT 1-800-648-0790                                   

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 PHARMACISTS AND PRESCRIBING PROVIDERS

EFFECTIVE OCTOBER 1, 2006, THE LMPBM UNIT WILL REQUIRE AN APPROPRIATE ICD-9-CM DIAGNOSIS CODE FOR PHARMACY CLAIMS FOR TAZAROTENE (TAZORAC*). THE PRESCRIBING PROVIDER MUST DOCUMENT THE DIAGNOSIS CODE ON THE HARDCOPY PRESCRIPTION OR CAN COMMUNICATE THE DIAGNOSIS CODE OVER THE PHONE. THE ACCEPTABLE ICD-9-CM DIAGNOSIS CODES ARE:                          

696.0 PSORIATIC ARTHROPATHY                                      
696.1 OTHER PSORIASIS                                            

THIS DOCUMENTATION SHALL BE RETAINED BY THE PHARMACY PROVIDER AS EVIDENCE OF COMPLIANCE WITH PROGRAM POLICY AND READILY RETRIEVABLE WHEN REQUESTED BY THE LMPBM AUDIT STAFF.

NATIONAL PROVIDER IDENTIFIER

DHH HAS LAUNCHED A NEW NPI WEB REGISTRATION SITE FOR PROVIDERS TO REGISTER THEIR NPI WITH LOUISIANA MEDICAID. CMS WILL REQUIRE ALL HIPAA STANDARD TRANSACTIONS, INCLUDING MEVS ELIGIBILITY INQUIRY AND CLAIMS STATUS INQUIRY TO BE SUBMITTED USING THE NPI NUMBER BEGINNING 23-MAY-07. THE NEW NPI APPLICATION IS ACCESSIBLE FROM THE LIST OF APPLICATIONS IN THE SECURED PROVIDER AREA OF THE WWW.LAMEDICAID.COM WEB SITE. FIND THIS AND MORE ON THE NPI INFORMATION PAGE ACCESSIBLE FROM WWW.LAMEDICAID.COM> HIPAA INFORMATION CENTER>NATIONAL PROVIDER IDENTIFIER (NPI)

ATTENTION PROVIDERS

THE OFFICE OF MANAGEMENT AND BUDGET (OMB), THE NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) AND THE NATIONAL UNIFORM BILLING COMMITTEE (NUBC) HAVE GIVEN WITH STAMP OF APPROVAL TO THE NEW 1500 HEALTH INSURANCE CLAIM FORM (VERSION 08/05) AND THE NEW UB-04 CLAIM FORM. THE LOGISTICS FOR DISTRIBUTION AND TRANSITION TO THESE REVISED FORMS, INCLUDING EFFECTIVE DATES FOR USE BY PROVIDERS AND ACCEPTANCE BY PAYERS, IS UNDER REVIEW BY THE COMMITTEES. IT IS VERY IMPORTANT THAT YOU DO NOT BEGIN USING THESE NEW FORMS FOR LA MEDICAID BILLING UNTIL YOU ARE INFORMED OF THE EFFECTIVE DATE OF THE TRANSITION FOR LA MEDICAID CLAIMS PROCESSING. YOU WILL BE KEPT INFORMED OF ALL NECESSARY INFORMATION FOR IMPLEMENTING THESE FORMS FOR LA MEDICAID BILLING THROUGH RA MESSAGES, NEWSLETTER ARTICLES, AND PROVIDER NOTICES POSTED ON OUR WEBSITE, WWW.LAMEDICAID.COM <HTTP://WWW. LAMEDICAID.COM/>. PLEASE WATCH THESE INFORMATION AVENUES FOR THE MOST UP-TO-DATE INFORMATION FOR BILLING LA MEDICAID. 

ATTENTION PHYSICIAN, HOSPITAL, RHC/FQHC/IHS PROVIDERS
NEW TAKE CHARGE FAMILY PLANNING WAIVER PROGRAM 

DHH WILL IMPLEMENT A SECTION 1115 DEMONSTRATION WAIVER TO PROVIDE FAMILY PLANNING SERVICES ONLY FOR WOMEN BETWEEN THE AGES OF 19-44 WHO DO NOT MEET MEDICAID CERTIFICATION CRITERIA BUT WHO HAVE INCOME UP TO 200% OF THE FEDERAL POVERTY LEVEL. THIS WAIVER PROGRAM, NAMED "TAKE CHARGE", HAS A SPECIFIED, LIMITED BENEFIT PACKAGE. SERVICES WILL INCLUDE YEARLY PHYSICAL EXAMS AND CERTAIN LABORATORY TESTS, CONTRACEPTIVE COUNSELING, MEDICATIONS, SUPPLIES, AND MEDICAL PROCEDURES. SERVICES MAY BE PROVIDED BY AN ENROLLED MEDICAID PROVIDER(S) WHOSE SCOPE OF PRACTICE PERMITS THE DELIVERY OF THE SERVICES COVERED BY THIS WAIVER PROGRAM. MORE SPECIFIC INFORMATION ABOUT THE TAKE CHARGE FAMILY PLANNING WAIVER WILL BE AVAILABLE IN A DETAILED PROVIDER NOTICE AT THE FOLLOWING LINKS:

HTTP://WWW.LAMEDICAID.COM/PROVWEB1/NEWINFORMATION/NEWINFORMATIONINDEX.HTM

HTTP://WWW.LAMEDICAID.COM/PROVWEB1/BILLING_INFORMATION/MEDICAID_BILLING_INDEX.HTM

THE IMPLEMENTATION DATE OF THE TAKE CHARGE FAMILY PLANNING WAIVER PROGRAM IS OCTOBER 2, 2006.

ATTENTION PROFESSIONAL SERVICES PROVIDERS

PROFESSIONAL SERVICES CLAIMS THAT IMPROPERLY PROCESSED REGARDING SERVICE LIMITS FOR DOS 1-5-06 THROUGH 7-26-06 AND WERE ADJUDICATED PRIOR TO 7-26-06 HAVE BEEN RECYCLED. THE RECYCLED CLAIMS WILL APPEAR ON YOUR RA. UNISYS PROVIDER RELATIONS MAY BE CONTACTED AT (800) 473-2783 OR (225) 924-5040 IF THERE ARE QUESTIONS CONCERNING THIS PROCESS.

ATTENTION PROFESSIONAL SERVICES PROVIDERS

IMPLEMENTATION OF THE PHYSICIAN SERVICES REIMBURSEMENT RATE INCREASE FOR OUTPATIENT OFFICE EVALUATION AND MANAGEMENT SERVICES, OUTPATIENT OFFICE CONSULTATION SERVICES, EMERGENCY DEPARTMENT SERVICES, PREVENTIVE MEDICINE SERVICES, AND GENERAL/INTEGUMENTARY SYSTEM CPT CODES, EFFECTIVE WITH DATE OF SERVICE OCTOBER 4, 2006, IS PENDING CMS APPROVAL. UPON  APPROVAL, CLAIMS FOR DOS OCTOBER 4, 2006 FORWARD WILL BE ADJUSTED. PROVIDERS WILL BE NOTIFIED OF THE STATUS OF THE APPROVAL AND ADJUSTMENTS VIA FUTURE RA MESSAGES.