RA Messages for October 28, 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.

Detailed FUL changes will be posted on www.lamedicaid.com with the next monthly update of appendix A.

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 14, 2008. 

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.

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.

PREFERRED DRUG LIST CHANGES/CORRECTIONS

Ciclopirox Suspension and Tolcapone (Tasmar) were listed incorrectly on the Preferred Drug List (PDL) effective November 1, 2008. The correct status is:

Ciclopirox Suspension - Preferred
Tolcapone (Tasmar) - Requires PA

Please reflect the noted changes on your copy of the PDL mailed October 20.

COVERAGE OF IMMUNIZATIONS FOR ADULT RECIPIENTS

Effective with date of service October 1, 2007, LA Medicaid reimburses professional service providers for select CPT procedure codes specific to immunizations for influenza, pneumococcal, and human papillomavirus diseases for adult recipients ages 21 and older. The necessary logic changes are complete to allow these services to be paid. Claims that have been held may now be submitted. Providers that have claims that were not initially submitted and are now over the timely filing limit must coordinate submission of the claims with Unisys Provider Relations at (800) 473-2783. A systematic claims recycle of all denied claims will occur in the near future and providers will be notified of the details in upcoming RA messages. A detailed provider notice and a fee schedule of vaccine codes covered by LA Medicaid are located on the LA Medicaid web site, www.lamedicaid.com, links New Medicaid Information and Fee Schedules, respectively.

ATTENTION: LONG TERM - PERSONAL CARE SERVICES

Some claims for procedure code T1019 with UB modifier were cut back erroneously, therefore these claims will be adjusted to allow payment for the correct number of units. The system adjustments will appear on your remittance dated 10/28/08.

There were also occurrences of claims with code T1019 that were paid without proper prior authorization information included. These claims will be voided on the remittance dated 10/28/08.