RA Messages for October 25, 2005

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 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 EDITS FOR PHARMACY PRIOR AUTHORIZATION (PA) WHICH WERE TEMPORARILY SUSPENDED DUE TO THE HURRICANES WILL BE REINSTATED ON OCTOBER 17, 2005. THE DRUG CATEGORIES THAT WERE REVIEWED AT THE AUGUST 17, 2005 P&T MEETING WILL BE IMPLEMENTED INTO THE PDL/PA PROCESS ON NOVEMBER 1, 2005. ALSO, THE PRESCRIPTION LIMIT THAT WAS TEMPORARILY SUSPENDED DUE TO THE HURRICANES WILL BE REINSTATED NOVEMBER 1, 2005. 

ATTENTION DENTAL PROVIDERS

EFFECTIVE NOVEMBER 1, 2005, CERTAIN DENTAL CODING, POLICY AND RELATED FEE REVISIONS WILL APPLY. DETAILED INFORMATION RELATED TO THESE REVISIONS IS LOCATED AT THE FOLLOWING WEBSITE: WWW.LAMEDICAID.COM UNDER THE LINK ENTITLED "NEW MEDICAID INFORMATION" AND UNDER THE HEADING OF "DENTAL PROVIDERS." IN ADDITION, THE REVISED FEE SCHEDULES FOR THE EPSDT DENTAL, ADULT DENTURE AND EXPANDED DENTAL SERVICES FOR PREGNANT WOMEN PROGRAMS ARE ALSO AVAILABLE AT THE ABOVE-REFERENCED WEBSITE UNDER THE LINK ENTITLED "FEE SCHEDULES." IF YOU DO NOT HAVE WEB ACCESS AND WISH TO REQUEST A HARDCOPY OF THE REVISED INFORMATION AND FEE SCHEDULES, YOU SHOULD CONTACT UNISYS PROVIDER RELATIONS AS SOON AS POSSIBLE BY CALLING (225)924-5040 OR TOLL-FREE @ (800)473-2783. 

ATTENTION PROVIDERS

EFFECTIVE SEPTEMBER 15, 2005, YOU MAY BILL ELECTRONICALLY FOR PROCEDURE CODE 99360 - PHYSICIAN STANDBY SERVICE. THESE CLAIMS WILL NO LONGER BE PENDED FOR MEDICAL REVIEW BUT INSTEAD WILL BE SUBJECT TO POST-PAYMENT REVIEW. 

ATTENTION PROVIDERS

THE 2006 ICD-9 DISEASE AND PROCEDURE CLASSIFICATION CODE UPDATE HAS BEEN COMPLETED AND WILL BE EFFECTIVE WITH DATES OF SERVICE 10/01/2005. CLAIMS WITH INVALID CODES BEARING A 10/01/2005 OR LATER DATE OF SERVICE WILL DENY. 

ATTENTION PROVIDERS OF STERILIZATION AND/OR HYSTERECTOMY PROCEDURES

HURRICANE KATRINA RELATED WAIVERS FOR STERILIZATION AND/OR HYSTERECTOMY 
PROCEDURES ARE POSTED IN DETAIL ON THE LOUISIANA MEDICAID WEBSITE @ WWW.LAMEDICAID.COM UNDER THE HURRICANE KATRINA LINK.

IMPORTANT INFORMATION REGARDING COMMUNITYCARE REFERRALS

THE COMMUNITYCARE REFERRAL AND KIDMED LINKAGE REQUIREMENTS WERE TEMPORARILY WAIVED FOR RECIPIENTS FROM THE 13 PARISHES MOST DIRECTLY AFFECTED BY HURRICANE KATRINA. THOSE WAIVERS WILL END EFFECTIVE WITH DATES OF SERVICE NOVEMBER 1, 2005, FOR ENROLLEES IN THE FOLLOWING PARISHES: ST. JAMES, LAFOURCHE, WASHINGTON, TANGIPAHOA, TERREBONNE, ST. CHARLES, AND ST. JOHN. THIS MEANS THAT IF YOU PROVIDE MEDICAL CARE TO A COMMUNITYCARE RECIPIENT FROM ONE OF THE ABOVE PARISHES, ON OR AFTER NOVEMBER 1, 2005, AND YOU ARE NOT THE PCP PROVIDER OF RECORD, YOU WILL NEED A REFERRAL FROM THE PCP IN ORDER TO BE PAID BY MEDICAID. SERVICES PROVIDED TO KIDMED ENROLLEES WHO ARE NOT IN COMMUNITYCARE MUST BE PROVIDED BY THE KIDMED PROVIDER OF RECORD. THE REQUIREMENT FOR A COMMUNITYCARE REFERRAL/KIDMED LINKAGE WAIVER WILL CONTINUE TO BE WAIVED FOR RECIPIENTS FROM ORLEANS, ST. BERNARD, PLAQUEMINES, EAST JEFFERSON, WEST JEFFERSON AND ST. TAMMANY PARISHES UNTIL FURTHER NOTICE. 

THE EFFECTIVE DATE OF THE WAIVER OF 60 DAYS TIMELY FILING OF KIDMED CLAIMS HAS BEEN CHANGED FROM AUGUST 27, 2005 TO AUGUST 01, 2005. THE WAIVER WILL END EFFECTIVE WITH DATES OF SERVICE NOVEMBER 1, 2005 FOR ALL PROVIDERS EXCEPT THOSE IN ORLEANS, WEST JEFFERSON, EAST JEFFERSON, ST. TAMMANY, ST. MARY, CAMERON, IBERIA, ST. BERNARD, PLAQUEMINES, CALCASIEU AND VERMILLION PARISHES. 

EFFECTIVE WITH DATES OF SERVICE SEPTEMBER 21, 2005-OCTOBER 31, 2005, THE COMMUNITYCARE REFERRAL AND KIDMED LINKAGE REQUIREMENTS WILL BE WAIVED FOR RECIPIENTS FROM ALLEN, BEAUREGARD, EVANGELINE, LAFAYETTE, VERNON, JEFFERSON DAVIS, ACADIA AND ST. MARTIN PARISHES. THIS MEANS THAT COMMUNITYCARE SERVICES PROVIDED TO RECIPIENTS FROM THE ABOVE PARISHES FOR DATES OF SERVICE SEPTEMBER 21, 2005-OCTOBER 31, 2005 DO NOT REQUIRE A REFERRAL FROM THE PCP, AND KIDMED ENROLLEES WHO ARE NOT IN COMMUNITY CARE CAN RECEIVE KIDMED SERVICES FROM ANY CERTIFIED LOUISIANA MEDICAID 
PROVIDER. IN ADDITION, THE SAME COMMUNITYCARE/KIDMED REQUIREMENTS MENTIONED ABOVE WILL BE WAIVED FOR RECIPIENTS FROM CALCASIEU, CAMERON, VERMILLION, IBERIA AND ST. MARY PARISHES FOR DATES OF SERVICE SEPTEMBER 21, 2005 UNTIL FURTHER NOTICE. 

CHIROPRACTIC SERVICES CHANGE

PROCEDURE CODES 97260 AND 97261 HAVE BEEN DELETED IN THE 'CURRENT PROCEDURAL TERMINOLOGY' MANUAL (CPT). EFFECTIVE WITH DATES OF SERVICE 9-1-05 FORWARD, CHIROPRACTORS SHOULD BILL FOR SERVICES USING THE CURRENT APPROPRIATE CPT CODE (98940 OR 98941) FOR THE SERVICE PROVIDED. LOUISIANA MEDICAID'S NON-ENHANCED FEE FOR THESE CODES IS BASED ON 80% OF THE 2005 MEDICARE ALLOWANCE. HCPCS MODIFIER 'AT' (ACUTE TREATMENT) MAY BE APPENDED. MEDICAID COVERAGE AND CRITERIA REGARDING THESE SERVICES HAS NOT CHANGED. CLAIMS USING CPT CODES 97260 AND 97261 THAT DENY EFFECTIVE 9-1-05 SHOULD BE RESUBMITTED USING CURRENT CODES.