RA Messages for October 16, 2001

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 MAKE THE FOLLOWING CHANGES TO THE 12/9/00 VERSION OF APPENDIX C:

LABELER  COMPANY  BEGIN END
65005 PTG LABS 01/01/02
66213 PBM PHARMACEUTICALS  01/01/02  

 PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

NOTICE TO ALL PROVIDERS

LOUISIANA MEDICAID PROVIDERS GAIN NEW TOOL TO BETTER SERVE THE PUBLIC  BATON ROUGE - ON TUESDAY OCTOBER 2, THE LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS LAUNCHED A NEW LOUISIANA MEDICAID PROVIDER WEBSITE,  WWW.LAMEDICAID.COM. THIS SITE ALLOWS PROVIDERS IN THE LOUISIANA  MEDICAID PROGRAM TO QUICKLY ACQUIRE THE MOST CURRENT INFORMATION ABOUT  THE PROGRAM IN ORDER TO BETTER SERVE MEDICAID RECIPIENTS STATEWIDE.   LOUISIANA MEDICAID PROVIDER WEBSITE ALSO INCLUDES BILLING INFORMATION  AND PROVIDER TRAINING INFORMATION. FURTHER DEVELOPMENT OF THE WEBSITE  WILL OFFER PROVIDER-SPECIFIC INTERACTIONS, WHICH ARE CURRENTLY HANDLED  BY PHONE OR MAIL. THIS NEW SITE WILL WORK IN CONJUNCTION WITH THE  NUMEROUS SERVICES ALREADY PROVIDED ON-LINE THROUGH THE STATE'S MEDICAID PROGRAM AT HTTP://WWW.DHH.STATE.LA.US/MEDICAID/INDEX.HTM 

NOTICE TO PROVIDERS

IN ORDER TO BE REVIEWED AND CONSIDERED FOR PAYMENT, PROVIDERS SUBMITTING CLAIMS FOR HIV DRUG RESISTANCE TESTING MUST HAVE THE FOLLOWING ATTACHED TO THE CLAIM: (1) THE RESULTS OF THE TESTING (2) PATIENT'S HISTORY JUSTIFYING THE NEED OF THE TESTING (EXAMPLES ARE (HAART), PREGNANCY, SUBOPTIMAL SUPPRESSION OF VIRAL LOAD AFTER INITIATION OF ANTIRECTROVIRAL THERAPY). ** ONE TEST OR COMBINATION OF TESTS IS PAYABLE PER 365 DAYS.

NOTICE TO KIDMED PROVIDERS

EPSDT CONSULT CODES (X0180-X0182, X0187-X0189) ARE TO BE SPECIFIC TO AN INDIVIDUAL CHILD'S NEEDS.  DOCUMENTATION SHOULD BE PRESENT AS TO THE NEED FOR THE CONSULT FOR THAT PARTICULAR CHILD.  OUTCOMES FOR THE CONSULTS ARE TO BE DOCUMENTED AS WELL AS REFERRALS TO APPROPRIATE RESOURCES FOR THOSE CONDITIONS THAT MIGHT REQUIRE FURTHER ATTENTION.  CONSULTS ARE TO BE FACE-T0-FACE CONTACT IN ONE-ON-ONE SESSION.  CONSULT CODES ARE NOT TO BE USED FOR ONGOING TREATMENT.  GROUP SESSIONS ARE NOT ALLOWED AND MULTIPLE UNITS MAY NOT BE BILLED FOR THE SAME CONTACT.