RA Messages for October 12, 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.

Detailed LMAC and FUL changes are posted on www.lamedicaid.com.

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 PHARMACY PROVIDERS

Updates to the Pharmacy Benefits Management Services Manual are now available on the Louisiana Medicaid website at www.lamedicaid.com. Pharmacy providers should refer to the manual for a complete description of Medicaid pharmacy program policy.

ATTENTION ALL DURABLE MEDICAL EQUIPMENT PROVIDERS (DME)

Medicaid has made the following codes payable. Please discontinue using the miscellaneous procedure code(s) (E1399) when requesting prior authorization. The payment methodology for the new codes remain the same as paid under E1399.

Proc Code           Eff. Date                 Description
A4483                 9/1/09             Moisture Exchanger
A4649                 9/1/09             Surgical Supplies Not Elsewhere Clas
A4606                 9/1/09             Oxygen Probe & Use with Oximeter Device - Reusable
B4088                 9/1/09             Gastrostomy/Jejunostomy Tube, Low-PR

ATTENTION MENTAL HEALTH REHABILITATION (MHR) PROVIDERS

Based upon the MHR service limits that were implemented on 8/4/09, claims that were received between dates of 8/4/09 and 8/17/09 are being recycled as the edit incorporating those limits was not in place during that time period. Claims for any service units in excess of the established limits will appear on your 10/13/09 remittance advice as a void. Your reimbursement for any current claims will then be reduced by the total of your voided claims. No provider action is necessary.

DIAGNOSIS CODE UPDATE

Effective with DOS October 1, 2009, the 2010 ICD-9 diagnosis codes and operation codes have been added to our files. The files have also been updated to deny those codes now considered invalid. Providers should use the most complete and appropriate diagnosis and operation codes when submitting claims to Louisiana Medicaid.

H1N1 INFLUENZA - IMPORTANT INFORMATION FOR
PROFESSIONAL SERVICES PROVIDERS (NON-PHARMACY)

Providers administering the H1N1 influenza vaccine to Louisiana Medicaid recipients may submit claims for the administration of this vaccine to Medicaid. The American Medical Association (AMA) has released two new Current Procedural Terminology (CPT) codes, one specifically for the H1N1 vaccine (90663) and one for the administration of the H1N1 vaccine (90470). As the H1N1 vaccine is being supplied at no charge by the Office of Public Health (OPH) and to only those providers that previously registered with the OPH, Medicaid will reimburse providers for the administration only of the vaccine. Detailed policy and a fee schedule specific to the H1N1 influenza vaccine/administration are available on the homepage of www.lamedicaid.com. Providers should contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with billing or policy questions. Questions related to the H1N1 vaccine including availability should be directed to the OPH Immunization Program at (504) 838-5300.

IMPORTANT NOTICE TO PROVIDERS

Various providers received two projects for the 3rd quarter Medicare Recovery Part A and Part B recoupment. Please disregard the project mailed by UNISYS titled Medicare Recovery Adj/Void Notification dated September 30, 2009. This project directs providers to send their responses to Eligibility Special Services to refute the recoupment. Please process the project received from (HMS) Health Management Systems on DHH Letterhead dated September 29, 2009, for Part B recoveries and October 6, 2009, for Part A recoveries. We apologize for any inconvenience.