RA Messages for October 27, 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 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.

ATTENTION PROVIDERS

A series of EHR software demonstrations will be hosted by the Louisiana Health Care Quality Forum beginning November 3, 2009. Each software company will demonstrate how their product would handle the tasks for a test patient in a typical office visit to a primary care physician. They each will demonstrate elements of meaningful use based on the same patient information and scenario. Each participating software vendor offers a CCHIT certified product and provides basic functionality as well as pricing information related to their product, which is available to providers gathering information. Webinars are scheduled to be hosted on Nov. 3, 5, 6, 9, 11, 12, 16 and 17th. All webinars will be from 12:00-1:00 p.m. Please visit the website at http://www.lhcqf.org for additional information.

ATTENTION PROVIDERS

The Louisiana Health Care Quality Forum will be hosting an educational EHR Adoption Conference in Baton Rouge on November 5, 2009. They would like to invite everyone to come and participate in the free conference so that one can learn about different financing opportunities available for EHR adoption as well as how LHCQF can help along the way. The invitation, agenda, and registration for the conference can be found at http://www.lhcqf.org.