RA Messages for October 21, 2008
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
Amlodipine Besylate
Tablet
2.5mg
0.1290
11/06/08
Amlodipine Besylate
Tablet
5mg
0.1290
11/06/08
Amlodipine Besylate
Tablet
10mg
0.1782
11/06/08
Azathioprine
Tablet
50mg
0.6581
11/06/08
Azithromycin
Tablet
250mg
3.1875
11/06/08
Azithromycin
Tablet
500mg
5.4850
11/06/08
Azithromycin
Tablet
600mg
6.9080
11/06/08
Bisoprolol Fumarate
Tablet
5mg
1.0688
11/06/08
Bisoprolol Fumarate
Tablet
10mg
1.0688
11/06/08
Bupropion HCL
SA Tablet 12HR 150mg
1.8330
11/06/08
Cefdinir
Capsule
300mg
3.8265
11/06/08
Cefdinir
Oral Susp
125mg/5ml
0.6231
11/06/08
Cefdinir
Oral Susp
250mg/5ml
1.3079
11/06/08
Cefprozil
Tablet
250mg
2.3939
11/06/08
Cefprozil
Tablet
500mg
4.5990
11/06/08
Ciclopirox Olamine
Top Susp
0.77%
1.5000
11/06/08
Clindamycin HCL
Capsule
300mg
2.0263
11/06/08
Divalproex Sodium
Tablet DR
125mg
0.2691
11/06/08
Divalproex Sodium
Tablet DR
250mg
0.5288
11/06/08
Divalproex Sodium
Tablet DR
500mg
0.9749
11/06/08
Fexofenadine HCL
Tablet
30mg
0.5756
11/06/08
Fexofenadine HCL
Tablet
60mg
1.1540
11/06/08
Fexofenadine HCL
Tablet
180mg
2.0018
11/06/08
Finasteride
Tablet
5mg
1.7303
11/06/08
Fosinopril Sodium
Tablet
10mg
0.5980
11/16/08
Fosinopril Sodium
Tablet
20mg
0.5980
11/16/08
Fosinopril Sodium
Tablet
40mg
0.5980
11/16/08
Metronidazole
Top Gel
0.75%
1.5417
11/06/08
Midodrine
Tablet
2.5mg
1.1172
11/06/08
Midodrine
Tablet
5mg
1.8383
11/06/08
Midodrine
Tablet
10mg
3.1338
11/06/08
Promthazine HCL
Tablet
12.5mg
0.4500
11/06/08
Quinapril Base
Tablet
5mg
0.2500
11/06/08
Quinapril Base
Tablet
10mg
0.2500
11/06/08
Quinapril Base
Tablet
20mg
0.2500
11/06/08
Quinapril Base
Tablet
40mg
0.2500
11/06/08
Ramipril
Capsule
1.25mg
0.4590
11/06/08
Ramipril
Capsule
2.50mg
0.4877
11/06/08
Ramipril
Capsule
5mg
0.5117
11/06/08
Ramipril
Capsule
10mg
0.5987
11/06/08
Simvastatin
Tablet
5mg
0.1750
11/06/08
Simvastatin
Tablet
10mg
0.1750
11/06/08
Simvastatin
Tablet
20mg
0.2100
11/06/08
Simvastatin
Tablet
40mg
0.2555
11/06/08
Simvastatin
Tablet
80mg
0.2555
11/06/08
Terbinafine HCL
Tablet
250mg
0.7050
11/06/08
Theophylline Anhydrous
Tablet SR
100mg
0.1971
11/06/08
Torsemide
Tablet
5mg
0.4500
11/06/08
Torsemide
Tablet
10mg
0.4800
11/06/08
Torsemide
Tablet
20mg
0.5250
11/06/08
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
The drug categories that
were reviewed at the August 13, 2008 P&T meeting will be implemented
into the PDL/PA process on November 1, 2008.
PHARMACY PROVIDERS, PLEASE NOTE
LMACs have been removed
from products which are now provided by a single manufacturer unless a
Federal Upper Limit is in place. Providers should refer to APPENDIX A
found at www.lamedicaid.com. The effective date of these changes is
October 15, 2008. Please file adjustments for claims that may have been
incorrectly paid.
ATTENTION ALL PROVIDERS
Effective for dates of
service October 1, 2008, forward, claims processing edits that were
lifted as a result of Hurricane Gustav as posted on the web site,
www.lamedicaid.com, will be reinstated. All providers should begin
following normal procedures for servicing and billing for LA Medicaid
recipients. CommunityCARE/KIDMED auto-assignments will resume with
linkages for October 2008. Emergency provider enrollment procedures will
be rescended at that time, also. Questions regarding these procedures
may be directed to Unisys Provider Relations at (800) 473-2783 or (225)
924-5040.
INTRODUCING HMS PROVIDER PORTAL
HMS, DHH's TPL contractor,
has developed an automated application (Provider Portal) for providers
to use in conjunction with recoupment projects (i.e., commercial
insurance and Medicare projects). The application has also been
customized to notify providers of claims paid by carriers to DHH as a
result of HMS billings so that providers can submit claims directly to
insurance carriers in accordance with Act 517 of the 2008 Louisiana
Statutes. Each provider must contact HMS to enroll in the Provider
Portal.
Please contact Ms. Amy Parks of HMS at 214-453-3132 or via email at
aparks@hms.com to complete your enrollment application. We hope you will
take advantage of this automated system. Thank you.
PEDIATRIC MODERATE (CONSCIOUS)
SEDATION:
CURRENT CPT CODES 99148, 99149 and 99150
Effective January 1, 2008,
Louisiana Medicaid will reimburse for moderate sedation services
provided by a physician other than the healthcare professional
performing the diagnostic or therapeutic service that the sedation
supports. Providers are responsible for adherence to the updated
"Pediatric Moderate (Conscious) Sedation" policy, which is located at
www.lamedicaid.com under "New Information," and will be published in an
upcoming "Louisiana Medicaid Provider Update."
ATTENTION HOSPITAL PROVIDERS
System changes have been
made to correct editing associated with primary and add-on codes for
screening mammograms. Louisiana Medicaid policy allows payment of one
screening mammogram per calendar year for females at least 40 years of
age. The screening mammogram may consist of one primary procedure and
one add-on procedure, each billed with HR403. For date of service
January 1, 2007, and forward, allowable HCPC codes are 77057 (primary)
and 77052 (add-on). For dates of service in 2006, allowable codes are
76092 (primary) and 76083 (add-on). Programming is now in place to allow
these codes to pay correctly. A recycle of claims for dates of service
January 1, 2006 - August 2, 2008, was recently completed and appeared on
the September 30, 2008, remittance advice.
ATTENTION DURABLE MEDICAL
EQUIPMENT PROVIDERS
Please be advised that
effective immediately, the department shall recognize procedure code
S8189 for custom trach tube. A letter of medical necessity explaining
why a custom trach tube is needed rather than a standard trach tube
along with a cost invoice should be attached with each Prior
Authorization (PA14) request.
ATTENTION CMHC PROVIDERS
The deadline for submitting
retroactive claims for processing by LA Medicaid has been extended
through November 30, 2008. Please ensure that all claims for the
retroactive period for which you intend to submit claims are received by
Unisys no later than November 30th. Beginning December 1, 2008,
crossover claims must be filed in accordance with timely filing
guidelines.