PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX C:

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

EFFECTIVE OCTOBER 1, 2006, THE LMPBM UNIT WILL REQUIRE AN APPROPRIATE ICD-9-CM DIAGNOSIS CODE FOR PHARMACY CLAIMS FOR TAZAROTENE (TAZORAC*). THE PRESCRIBING PROVIDER MUST DOCUMENT THE DIAGNOSIS CODE ON THE HARDCOPY PRESCRIPTION OR CAN COMMUNICATE THE DIAGNOSIS CODE OVER THE PHONE. THE ACCEPTABLE ICD-9-CM DIAGNOSIS CODES ARE:                          

696.0 PSORIATIC ARTHROPATHY                                      
696.1 OTHER PSORIASIS                                            

THIS DOCUMENTATION SHALL BE RETAINED BY THE PHARMACY PROVIDER AS EVIDENCE OF COMPLIANCE WITH PROGRAM POLICY AND READILY RETRIEVABLE WHEN REQUESTED BY THE LMPBM AUDIT STAFF.

ATTENTION DENTAL PROVIDERS

IN THE NEAR FUTURE, MEDICAID WILL RECYCLE DENTAL CLAIMS THAT ERRONEOUSLY DENIED FOR EXCEEDING SERVICE LIMITS WITH ERROR CODES 605, 741, & 901 FOR DATES OF SERVICE 1/5/2006 THROUGH 7/26/2006. MEDICAID WILL ALSO RECYCLE RHC/FQHC DENTAL PROVIDER ENCOUNTER CLAIMS FOR THESE DATES OF SERVICE THAT ERRONEOUSLY DENIED WITH ERROR CODE 136 DUE TO AN INCORRECT SERVICE LIMIT DENIAL OF A DETAIL CLAIM LINE. THE RECYCLED CLAIMS WILL APPEAR ON YOUR RA. IF YOU HAVE ANY QUESTIONS, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225)924-5040. 

ATTENTION PROVIDERS

THE OFFICE OF MANAGEMENT AND BUDGET (OMB), THE NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) AND THE NATIONAL UNIFORM BILLING COMMITTEE (NUBC) HAVE GIVEN WITH STAMP OF APPROVAL TO THE NEW 1500 HEALTH INSURANCE CLAIM FORM (VERSION 08/05) AND THE NEW UB-04 CLAIM FORM. THE LOGISTICS FOR DISTRIBUTION AND TRANSITION TO THESE REVISED FORMS, INCLUDING EFFECTIVE DATES FOR USE BY PROVIDERS AND ACCEPTANCE BY PAYERS, IS UNDER REVIEW BY THE COMMITTEES. IT IS VERY IMPORTANT THAT YOU DO NOT BEGIN USING THESE NEW FORMS FOR LA MEDICAID BILLING UNTIL YOU ARE INFORMED OF THE EFFECTIVE DATE OF THE TRANSITION FOR LA MEDICAID CLAIMS PROCESSING. YOU WILL BE KEPT INFORMED OF ALL NECESSARY INFORMATION FOR IMPLEMENTING THESE FORMS FOR LA MEDICAID BILLING THROUGH RA MESSAGES, NEWSLETTER ARTICLES, AND PROVIDER NOTICES POSTED ON OUR WEBSITE, WWW.LAMEDICAID.COM <HTTP://WWW. LAMEDICAID.COM/>. PLEASE WATCH THESE INFORMATION AVENUES FOR THE MOST UP-TO-DATE INFORMATION FOR BILLING LA MEDICAID. 

ATTENTION PHYSICIAN, HOSPITAL, RHC/FQHC/IHS PROVIDERS
NEW TAKE CHARGE FAMILY PLANNING WAIVER PROGRAM 

DHH WILL IMPLEMENT A SECTION 1115 DEMONSTRATION WAIVER TO PROVIDE FAMILY PLANNING SERVICES ONLY FOR WOMEN BETWEEN THE AGES OF 19-44 WHO DO NOT MEET MEDICAID CERTIFICATION CRITERIA BUT WHO HAVE INCOME UP TO 200% OF THE FEDERAL POVERTY LEVEL. THIS WAIVER PROGRAM, NAMED "TAKE CHARGE", HAS A SPECIFIED, LIMITED BENEFIT PACKAGE. SERVICES WILL INCLUDE YEARLY PHYSICAL EXAMS AND CERTAIN LABORATORY TESTS, CONTRACEPTIVE COUNSELING, MEDICATIONS, SUPPLIES, AND MEDICAL PROCEDURES. SERVICES MAY BE PROVIDED BY AN ENROLLED MEDICAID PROVIDER(S) WHOSE SCOPE OF PRACTICE PERMITS THE DELIVERY OF THE SERVICES COVERED BY THIS WAIVER PROGRAM. MORE SPECIFIC INFORMATION ABOUT THE TAKE CHARGE FAMILY PLANNING WAIVER WILL BE AVAILABLE IN A DETAILED PROVIDER NOTICE AT THE FOLLOWING LINKS:

HTTP://WWW.LAMEDICAID.COM/PROVWEB1/NEWINFORMATION/NEWINFORMATIONINDEX.HTM

HTTP://WWW.LAMEDICAID.COM/PROVWEB1/BILLING_INFORMATION/MEDICAID_BILLING_INDEX.HTM

THE IMPLEMENTATION DATE OF THE TAKE CHARGE FAMILY PLANNING WAIVER PROGRAM IS OCTOBER 2, 2006.

ATTENTION PROVIDERS

MEDICAID WILL RECYCLE HOME HEALTH AND DME CLAIMS THAT ERRONEOUSLY DENIED FOR EXCEEDING SERVICE LIMITS WITH ERROR CODES 390, 402, 664, 734, 739, 748, 784, 901, 902, 906 AND 917 WITH DATES OF PAYMENT THROUGH JULY 26, 2006. THE RECYCLED CLAIMS WILL APPEAR ON YOUR REMITTANCE ADVICE. IF YOU HAVE ANY QUESTIONS, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225)924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS

A SYSTEM PROCESSING ERROR CREATED DUPLICATE MEDICARE PART B CROSSOVER CLAIM PAYMENTS. THESE DUPLICATE CLAIMS ARE BEING VOIDED AND THE RECOUPMENT ACTIONS REFLECTED IN THE 10/03/06 REMITTANCES. PROVIDERS NEED NOT TAKE ANY ACTIONS TO CORRECT THESE PAYMENTS.