RA Messages for October 20, 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 FUL EFF
ANTIPYRINE/BENZOCAINE/GLYCER
DROPS 5.4%-1.4% OFF LMAC 20090925
BENZTROPINE
MESYLATE TABLET 0.5 MG 0.07470 20091026
BENZTROPINE
MESYLATE TABLET 1 MG 0.08480 20091026
BICALUTAMIDE
TABLET 50 MG 3.48020 20091026
BENZTROPINE
MESYLATE TABLET 2 MG 0.12080 20091026
CARBAMAZEPINE
TABLET 200 MG 0.08490 20091026
CEPHALEXIN
CAPSULE 250 MG 0.16500 20091026
CEPHALEXIN
CAPSULE 500 MG 0.27300 20091026
CEPHALEXIN
ORAL SUSP 250 MG 0.18180 20091026
CYCLOBENZAPRINE
HCL TABLET 10 MG 0.10350 20091026
CYCLOBENZAPRINE
HCL TABLET 50 MG 0.15860 20091026
DICLOFENAC
POTASSIUM TABLET 50 MG 0.15860 20091026
HYDROCHLOROTHIAZIDE
TABLET 25 MG 0.01800 20091026
HYDROCHLOROTHIAZIDE
TABLET 50 MG 0.0499 20091026
RANITIDINE
HCL SYRUP 15 MG 0.23780 20091026
RANITIDINE
HCL TABLET 150 MG 0.06000 20091026
RANITIDINE
HCL TABLET 300 MG 0.12500 20091026
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 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.
ATTENTION
HOSPITAL PROVIDERS
As the LA
Medicaid Program strives to eliminate a budget deficit, effective with
date of service August 4, 2009, forward, rate reductions have been
implemented for hospitals as follows: Non-Rural, Non-State Inpatient
Services (including Distinct Part Psychiatric Units) - 6.3% cut;
Non-Rural, Non-State Free-Standing Psychiatric Hospitals -5.8% cut;
Non-rural, Non-State Outpatient Services - 5.65% cut. Letters detailing
each individual hospital's rate cuts were mailed by DHH to providers on
September 30, 2009. Affected claims are systematically adjusted to
reflect these reductions on this RA (10/20/09). This recycle includes
claims for dates of service 08/04/09 forward that were paid at the rate
prior to the implementation of this rate reduction. Revised outpatient
services fee schedules reflecting the reduction are posted on the LA
Medicaid website, www.lamedicaid.com,
under the Fee Schedules link.
IMPORTANT
NOTICE TO ALL MEDICAID PROVIDERS AND VENDORS
Due to a
shortage of Louisiana Medicaid 7-digit provider numbers to enroll new
providers, we will increase the availability of these numbers for
assignment to newly enrolled providers by using numbers that begin with
"2" as the first digit of the number. By the end of this year, LA
Medicaid will convert all systems to accept 7-digit provider numbers
beginning with "2". LA Medicaid provider numbers beginning with "1" will
continue to be valid and accepted. Please see the homepage at our
website, www.lamedicaid.com, for additional information and continue to
watch RA messages and the website for definite dates of this conversion.