RA Messages for October 15, 2007

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                                                                    DOSAGE                               STRGTH            MAC            EFF. DATE

FOLIC ACID/VIT B COMP&C/ZINC                       TAB                                       1MG              $0.24205             8/16/07

 

PLEASE NOTE THE FOLLOWING CHANGES TO APPENDIX C:

LABELER         COMPANY                                                                                  BEGIN                                      END

 

64899                 F. DOHMAN                                                                                                                                  10/01/07

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
 

DELAY OF TAMPER-RESISTANT PRESCRIPTION PAD POLICY

A PROVISION IN THE "U.S. TROOP READINESS, VETERANS' HEALTH CARE, KATRINA RECOVERY AND IRAQ ACCOUNTABILITY APPROPRIATIONS ACT OF 2007" (H.R. 2206) REQUIRES THE USE OF TAMPER RESISTANT PRESCRIPTION DRUG PADS FOR WRITTEN, NON-ELECTRONIC PRESCRIPTIONS FOR MEDICAID RECIPIENTS. THIS PROVISION WAS TO BE EFFECTIVE 10-1-07. HOWEVER, THE "TMA, ABSTINENCE EDUCATION AND QI PROGRAM EXTENSION ACT OF 2007" (H.R. 3668) WAS ENACTED, THUS DELAYING THE IMPLEMENTATION UNTIL APRIL 1, 2008. PLEASE REFER TO WWW.LAMEDICAID.COM FOR ADDITIONAL POLICY INFORMATION INCLUDING A RECENT FAQ REGARDING TAMPER RESISTANT PRESCRIPTION PADS.

ATTENTION ALL HOME HEALTH PROVIDERS


THE DEPARTMENT IS PLEASED TO ANNOUNCE EFFECTIVE FOR DATES OF SERVICE ON OR AFTER JULY 20, 2007, THE REIMBURSEMENT RATES FOR EXTENDED NURSING SERVICES ARE INCREASED AS FOLLOWS:
1. S9123-NURSING CARE IN THE HOME PERFORMED BY A REGISTERED NURSE (RN) IS INCREASED TO $34.00 PER HOUR.
2. S9124-NURSING CARE IN THE HOME PERFORMED BY LICENSED PRACTICAL NURSE (LPN) IS INCREASED TO $32.00 PER HOUR.
3. S9123 TT-NURSING CARE FOR MULTIPLE RECIPIENTS IN THE HOME PERFORMED BY A REGISTERED NURSE (RN) IS INCREASED TO $17.00 PER HOUR.
4. S9124 TT-NURSING CARE FOR MULTIPLE RECIPIENTS IN THE HOME PERFORMED BY LICENSED PRACTICAL NURSE (LPN) IS INCREASED TO $16.00 PER HOUR.
SHOULD YOU HAVE ANY QUESTIONS RELATED TO THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS AT 1-800-473-2783 OR 225-924-5040.

HOSPITALS - INCORRECT PAYMENT OF AMBULATORY SURGERY CLAIMS


PROVIDERS WHICH WERE INCORRECTLY REIMBURSED FOR AMBULATORY SURGERY CLAIMS (HR490) FROM OCTOBER 2005 TO APRIL 2007 MAY SUBMIT VOIDS FOR THE INCORRECTLY PAID CLAIMS AND RESUBMIT CLAIMS WITH PROOF OF TIMELY FILING TO THE CLAIMS PROCESSING UNIT OF UNISYS. DHH IS UNABLE TO RE-PROCESS THESE CLAIMS. REMEMBER OUTPATIENT CLAIMS ARE PAID PER LINE, THEREFORE, ALL CLAIM LINES MUST BE VOIDED. DHH WILL NOT APPROVE OVERRIDES FOR CLAIMS OVER 2 YEARS OLD.

ATTENTION PROFESSIONAL SERVICES PROVIDERS


EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2007, LOUISIANA MEDICAID REIMBURSES FOR INPATIENT CONCURRENT CARE FOR ADULTS. INPATIENT CONCURRENT CARE IS DEFINED AS THE PROVISION OF SERVICES BY MORE THAN ONE PHYSICIAN TO A PATIENT ON THE SAME DAY. LOUISIANA MEDICAID WILL REIMBURSE UP TO THREE MEDICALLY NECESSARY HOSPITAL INPATIENT SERVICE VISITS PER DAY FOR ADULT RECIPIENTS (AGED 21 YEARS AND OLDER), FOR PROVIDERS OF DIFFERENT SPECIALTIES/SUBSPECIALTIES. PROVIDERS ARE RESPONSIBLE FOR ADHERENCE TO THE INPATIENT CONCURRENT CARE (ADULT) POLICY WHICH IS LOCATED ON THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM USING THE APPROPRIATE LINK & WILL BE PUBLISHED IN LOUISIANA MEDICAID PROVIDER UPDATE. ANY NEW OR PREVIOUSLY DENIED CLAIMS (DENIAL DUE TO DAILY LIMIT EXCEEDED) FOR INPATIENT SERVICES MAY BE RESUBMITTED EITHER ELECTRONICALLY OR HARDCOPY.

ATTENTION INDIVIDUAL PROFESSIONAL SERVICES PROVIDERS


RE: SPECIALTY/SUBSPECIALTY UPDATE


TO ALLOW APPROPRIATE CLAIMS PROCESSING WHEN REIMBURSEMENT IS BASED ON SPECIALTY/SUBSPECIALTY, INDIVIDUAL PROVIDERS ARE ENCOURAGED TO CONFIRM THAT THEIR MEDICAID PROVIDER FILE ACCURATELY REFLECTS THEIR SPECIALTY/SUBSPECIALTY. IF CHANGES ARE REQUIRED, THE PROVIDER ENROLLMENT SPECIALTY CHANGE FORM CAN BE ACCESSED ON-LINE AT WWW.LAMEDICAID.COM, USING LINKS: 'PROVIDER ENROLLMENT' & 'FORMS TO UPDATE EXISTING PROVIDER INFORMATION', RESPECTIVELY. COMPLETED FORMS ARE TO BE MAILED AS DIRECTED TO: UNISYS PROVIDER ENROLLMENT, PO BOX 80159, BATON ROUGE, LA 70898-0159

ATTENTION EDI SUBMITTERS


THE 2008 EDI ANNUAL CERTIFICATION FORMS HAVE BEEN MAILED. THE FORM IS ALSO LOCATED ON WWW.LAMEDICAID.COM UNDER EDI INFO. PLEASE COMPLETE AND RETURN THE 2008 ANNUAL CERTIFICATION FORM TO THE UNISYS EDI DEPARTMENT
BY DECEMBER 31, 2007 TO AVOID CLOSURE OF YOUR SUBMITTER NUMBER.

ATTENTION PROVIDERS ADMINISTERING IMMUNIZATIONS


IMMUNIZATION ADMINISTRATION CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES 90465-90648, 90473, AND 90474 HAVE BEEN MADE PAYABLE AND ADDED TO THE CURRENT CLAIMS PROCESSING SYSTEM. PROVIDERS SHOULD REFER TO THE CPT CODE DESCRIPTION TO DETERMINE THE APPROPRIATE CODE FOR THE ADMINISTRATION OF A VACCINE. UPDATED INFORMATION REGARDING USE OF THESE CODES CAN BE FOUND IN THE 2007 PROVIDER TRAINING MATERIALS FOR KIDMED AND PROFESSIONAL SERVICES. PREVIOUSLY DENIED CLAIMS FOR THESE IMMUNIZATION ADMINISTRATION CODES WILL BE RECYCLED FROM DATE OF SERVICE JANUARY 1, 2006 FORWARD. PROVIDERS WILL BE NOTIFIED BY RA MESSAGES WHEN THIS IS COMPLETE.