RA Messages for October 23, 2001

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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.

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

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

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ATTENTION PHARMACY PROVIDERS

IF YOU ARE AN INDEPENDENT OR CHAIN PHARMACY, YOU MAY RECEIVE A VERY IMPORTANT QUESTIONNAIRE WITHIN THE NEXT FEW DAYS.  PLEASE TAKE A FEW MOMENTS TO COMPLETE IT AND RETURN TO US IN THE SELF-ADDRESSED ENVELOPE YOU WILL RECEIVE.  YOUR RESPONSE IS VITAL TO OUR EFFORTS TO CONTINUE THE "PAY AND CHASE" METHOD OF PHARMACY BILLING IN LOUISIANA AS OPPOSED TO THE COST-AVOIDANCE METHOD WHICH REQUIRES PHARMACIES TO BILL PRIVATE INSURANCE CARRIERS FIRST.  YOUR HELP IN THIS MATTER WILL BE GREATLY APPRECIATED.  PLEASE NOTE THAT THE CORRECT RETURN DATE IS NOVEMBER 5TH AND DISREGARD THE OCTOBER 5TH DATE SHOWN ON THE SURVEY.

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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 

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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.

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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.

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NOTICE TO CERTIFIED NURSE PRACTITIONERS

EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2001, THE FOLLOWING CPT CODE
WILL BE ADDED TO THE LIST OF CODES PAYABLE TO CERTIFIED NURSE 
PRACTITIONERS - 31515 - LARYNOGOSCOPY DIRECT, WITH OR WITHOUT 
TRACHEOSCOPY; FOR ASPIRATION. 

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NOTICE TO ALL HEMODIALYSIS CENTERS

TO FACILITATE MEDICAID PAYMENTS AT THE MEDICARE RATE, ALL END STAGE 
RENAL DISEASE FACILITIES MUST SUBMIT THEIR CURRENT RATE ASSIGNED BY 
MEDICARE TO THE DEPARTMENT OF HEALTH AND HOSPITALS BY OCTOBER 25, 2001. 
THE COMPOSITE RATES MAY BE MAILED TO THE ATTENTION OF GAIL WILLIAMS, BIN
24, P.O. BOX 91030, BATON ROUGE, LA 70821-9103, OR FAXED TO GAIL'S 
ATTENTION AT 225-342-1411. 

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

THE FEE FOR CPT CODE J1055 (DEPO-PROVERA CONTRACEPTIVE INJECTION 150 
MG/ML) WILL BE INCREASED TO $53.54 EFFECTIVE WITH DATE OF SERVICE 
NOVEMBER 1, 2001. 

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

CPT CODE 90508 (CATHETER PLACEMENT IN CORONAY ARTERY(S), ARTERIAL 
CORONARY CONDUIT(S), AND/OR VENOUA CORONARY BYPASS GRAFT(S) FOR CORONARY
ANGIOGRAPHY WITHOUT CONCOMITANT LEFT HEART CATHETERIZATION SHOULD BE 
INCLUDED IN THE PERFORMANCE OF CPT CODE 92980 (TRANSCATHETER PLACEMENT 
OF INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITHOUT OTHER 
THERAPEUTIC INTERVENTION, ANY METHOD; SINGLE VESSEL). THE ONLY TIME BOTH
PROCEDURES MAY JUSTIFIABLY BE BILLED ON THE SAME DATE OF SERVICE FOR THE
SAME RECIPIENT IS WHEN THE PATIENT EXPERIENCES CHEST PAIN AFTER 
PLACEMENT AND THE POSSIBILITY EXISTS THAT THE STENT HAS CLOSED. IN THESE
CASES, THE PROVIDER MUST REQUEST THE CLAIM BE RECONSIDERED FOR PAYMENT, 
AS EDITS WILL SOON BE PLACED IN THE SYSTEM TO DENY CODE 90508 IF THERE 
IS ALREADY A PAID CLAIM FOR CODE 92982, 92995, OR 92980 IN HISTORY FOR 
THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT. LIKEWISE, A CLAIM FOR 
92980, 92982, AND 92995 WILL DENY IF THERE IS A PAID 90508 IN HISTORY.