RA Messages for October 2, 2007

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 C:

 

LABELER         COMPANY                                                                                  BEGIN                                      END

 

64899                 F. DOHMAN                                                                                                                                  10/01/07

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

USE OF TAMPER-RESISTANT PRESCRIPTION PADS

A PROVISION IN THE U.S. TROOP READINESS, VETERANS' HEALTH CARE, KATRINA RECOVERY AND IRAQ ACCOUNTABILITY APPROPRIATIONS ACT OF 2007 (H.R. 2206), SECTION 7002(B) REQUIRES THE USE OF TAMPER-RESISTANT PRESCRIPTION DRUG PADS FOR WRITTEN, NON-ELECTRONIC PRESCRIPTIONS FOR MEDICAID RECIPIENTS. THIS PROVISION IS EFFECTIVE 10-1-07. IN AN EFFORT TO REDUCE INSTANCES OF UNAUTHORIZED, IMPROPERLY ALTERED AND COUNTERFEIT PRESCRIPTIONS, ALL WRITTEN PRESCRIPTIONS REIMBURSED BY LOUISIANA MEDICAID ARE SUBJECT TO THIS STATUTORY REQUIREMENT.

PLEASE REFER TO WWW.LAMEDICAID.COM FOR ADDITIONAL POLICY INFORMATION INCLUDING RECENTLY RELEASED FREQUENTLY ASKED QUESTIONS REGARDING TAMPER-RESISTANT PRESCRIPTION PADS.

ATTENTION DENTAL PROVIDERS - NOTIFICATION

ADDRESS & TELEPHONE NUMBER CHANGE FOR THE LSU DENTAL MEDICAID UNIT EFFECTIVE IMMEDIATELY, DENTAL PROVIDERS MUST BEGIN USING THE FOLLOWING NEW ADDRESS WHEN SUBMITTING DENTAL PRIOR AUTHORIZATION REQUESTS OR OTHER DENTAL-RELATED CORRESPONDENCE TO THE LSU DENTAL MEDICAID UNIT: LSU DENTAL MEDICAID UNIT, P.O. BOX 19085, NEW ORLEANS, LA 70179-9085. THE NEW TELEPHONE NUMBERS FOR THE LSU DENTAL MEDICAID UNIT ARE AS FOLLOWS: 504-941-8206 OR 1-866-263-6534 (TOLL-FREE).

ATTENTION PROVIDERS AND ENTITIES

THE DEFICIT REDUCTION ACT OF 2005, SECTION 6032 IMPLEMENTATION. AS A CONDITION OF PAYMENT FOR GOODS, SERVICES AND SUPPLIES PROVIDED TO RECIPIENTS OF THE MEDICAID PROGRAM, PROVIDERS AND ENTITIES MUST COMPLY WITH THE FALSE CLAIMS ACT EMPLOYEE TRAINING AND POLICY REQUIREMENTS IN 1902(A)(68) OF THE SOCIAL SECURITY ACT, SET FORTH IN THAT SUBSECTION AND AS THE SECRETARY OF US DEPARTMENT OF HEALTH AND HUMAN SERVICES MAY SPECIFY.

AS AN ENROLLED PROVIDER/ENTITY, IT IS YOUR OBLIGATION TO INFORM ALL OF YOUR EMPLOYEES AND AFFILIATES OF THE PROVISIONS OF THE FEDERAL FALSE CLAIMS ACT, AND ANY LOUISIANA LAWS AND/OR RULES PERTAINING TO CIVIL OR CRIMINAL PENALTIES FOR FALSE CLAIMS AND STATEMENTS, AND WHISTLEBLOWER PROTECTIONS UNDER SUCH LAWS AND/OR RULES. WHEN MONITORED OR AUDITED, YOU WILL BE REQUIRED TO SHOW EVIDENCE OF COMPLIANCE WITH THIS REQUIREMENT. THIS PROVISION REQUIRES ANY ENTITY THAT RECEIVES ANNUAL MEDICAID PAYMENTS UNDER THE STATE PLAN OF AT LEAST $5 MILLION TO PROVIDE FEDERAL FALSE CLAIMS ACT EDUCATION TO THEIR EMPLOYEES.

ATTENTION HOSPICE PROVIDERS - MSA CODE ASSIGNMENT

EFFECTIVE WITH DATES OF SERVICE 10/1/07, THE MSA CODES CURRENTLY USED FOR BILLING HOSPICE SERVICES IN THE FOLLOWING PARISHES HAVE BEEN CHANGED TO:

CAMERON-3960         GRANT-0220                      DESOTO-7680             E. FELICIANA-0760

IBERVILLE-0760          POINTE COUPEE-0760     ST.HELENA-0760       UNION-5200

SUSPENSION OF LINE-ITEM BILLING REQUIREMENT

IN ORDER TO ALLOW FOR CONSIDERATION OF COMMENTS RECEIVED AS A RESULT OF A PROVIDER NOTICE DATED AUGUST 23, 2007, WE ARE SUSPENDING THE LINE-ITEM BILLING REQUIREMENT UNTIL FURTHER NOTICE FOR WAIVER PROVIDER TYPE 82 (WAIVER-- PERSONAL CARE ATTENDANT) AND WAIVER PROVIDER TYPE 89 (WAIVER--SUPPORTIVE INDEPENDENT LIVING). THIS REQUIREMENT HAS NOT BEEN LIFTED FOR TYPE 24 PROVIDERS (PERSONAL CARE SERVICE). PROVIDERS OF EPSDT PERSONAL CARE SERVICES AND LONG TERM-PERSONAL CARE SERVICES WILL BE REQUIRED TO LINE-ITEM BILL FOR DATES OF SERVICE ON OR AFTER OCTOBER 1, 2007.

ATTENTION PHARMACY PROVIDERS

PHARMACY PROVIDERS - PAID CLAIMS WITH MISSING OR INVALID "PRESCRIBER ID#S" HAVE BEEN IDENTIFIED. THESE MAY & JUNE 2007 CLAIMS WILL BE VOIDED ON THIS WEEK'S RA WITHIN AN ICN # RANGE OF 7266488700200 THROUGH 7266488780600. PROVIDERS HAVE THE OPTION TO RESUBMIT THESE CLAIMS WITH CORRECTED PRESCRIBER PROVIDER NUMBERS.

ATTENTION PROVIDERS ADMINISTERING IMMUNIZATIONS

IMMUNIZATION ADMINISTRATION CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES 90465-90648, 90473, AND 90474 HAVE BEEN MADE PAYABLE AND ADDED TO THE CURRENT CLAIMS PROCESSING SYSTEM. PROVIDERS SHOULD REFER TO THE CPT CODE DESCRIPTION TO DETERMINE THE APPROPRIATE CODE FOR THE ADMINISTRATION OF A VACCINE. UPDATED INFORMATION REGARDING USE OF THESE CODES CAN BE FOUND IN THE 2007 PROVIDER TRAINING MATERIALS FOR KIDMED AND PROFESSIONAL SERVICES.

PREVIOUSLY DENIED CLAIMS FOR THESE IMMUNIZATION ADMINISTRATION CODES WILL BE SYSTEMATICALLY RECYCLED FROM DATE OF SERVICE JANUARY 1, 2006 FORWARD. PROVIDERS WILL BE NOTIFIED BY RA MESSAGES WHEN THIS RECYCLE OF DENIED CLAIMS IS COMPLETE.