RA Messages for October 9, 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 A:

DRUG                                                                    DOSAGE                               STRGTH            MAC            EFF. DATE

FOLIC ACID/VIT B COMP&C/ZINC                       TAB                                       1MG              $0.24205             8/16/07

 

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
 

DELAY OF TAMPER-RESISTANT PRESCRIPTION PAD POLICY

A PROVISION IN THE "U.S. TROOP READINESS, VETERANS' HEALTH CARE, KATRINA RECOVERY AND IRAQ ACCOUNTABILITY APPROPRIATIONS ACT OF 2007" (H.R. 2206) REQUIRES THE USE OF TAMPER RESISTANT PRESCRIPTION DRUG PADS FOR WRITTEN, NON-ELECTRONIC PRESCRIPTIONS FOR MEDICAID RECIPIENTS. THIS PROVISION WAS TO BE EFFECTIVE 10-1-07. HOWEVER, THE "TMA, ABSTINENCE EDUCATION AND QI PROGRAM EXTENSION ACT OF 2007" (H.R. 3668) WAS ENACTED, THUS DELAYING THE IMPLEMENTATION UNTIL APRIL 1, 2008. PLEASE REFER TO WWW.LAMEDICAID.COM FOR ADDITIONAL POLICY INFORMATION INCLUDING A RECENT FAQ REGARDING TAMPER RESISTANT PRESCRIPTION PADS.

ATTENTION ALL HOME HEALTH PROVIDERS


THE DEPARTMENT IS PLEASED TO ANNOUNCE EFFECTIVE FOR DATES OF SERVICE ON OR AFTER JULY 20, 2007, THE REIMBURSEMENT RATES FOR EXTENDED NURSING SERVICES ARE INCREASED AS FOLLOWS:
1. S9123-NURSING CARE IN THE HOME PERFORMED BY A REGISTERED NURSE (RN) IS INCREASED TO $34.00 PER HOUR.
2. S9124-NURSING CARE IN THE HOME PERFORMED BY LICENSED PRACTICAL NURSE (LPN) IS INCREASED TO $32.00 PER HOUR.
3. S9123 TT-NURSING CARE FOR MULTIPLE RECIPIENTS IN THE HOME PERFORMED BY A REGISTERED NURSE (RN) IS INCREASED TO $17.00 PER HOUR.
4. S9124 TT-NURSING CARE FOR MULTIPLE RECIPIENTS IN THE HOME PERFORMED BY LICENSED PRACTICAL NURSE (LPN) IS INCREASED TO $16.00 PER HOUR.
SHOULD YOU HAVE ANY QUESTIONS RELATED TO THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS AT 1-800-473-2783 OR 225-924-5040.

HOSPITALS - INCORRECT PAYMENT OF AMBULATORY SURGERY CLAIMS


PROVIDERS WHICH WERE INCORRECTLY REIMBURSED FOR AMBULATORY SURGERY CLAIMS (HR490) FROM OCTOBER 2005 TO APRIL 2007 MAY SUBMIT VOIDS FOR THE INCORRECTLY PAID CLAIMS AND RESUBMIT CLAIMS WITH PROOF OF TIMELY FILING TO THE CLAIMS PROCESSING UNIT OF UNISYS. DHH IS UNABLE TO RE-PROCESS THESE CLAIMS. REMEMBER OUTPATIENT CLAIMS ARE PAID PER LINE, THEREFORE, ALL CLAIM LINES MUST BE VOIDED. DHH WILL NOT APPROVE OVERRIDES FOR CLAIMS OVER 2 YEARS OLD.

HOSPITALS - CERTIFICATION FOR ORGAN TRANSPLANT CENTERS


THIS IS A REMINDER THAT CMS REQUIRES ALL HOSPITAL TRANSPLANT CENTERS CURRENTLY APPROVED FOR MEDICARE PARTICIPATION TO SUBMIT A REQUEST FOR NEW APPROVAL UNDER THE CONDITIONS OF PARTICIPATION ESTABLISHED BY THE NEW REGULATIONS ISSUED ON MARCH 30, 2007. INFORMATION MAY BE OBTAINED FROM THE CMS WEBSITE. ALL REQUESTS MUST BE SUBMITTED TO CMS BY 12/26/07.

ATTENTION PROFESSIONAL SERVICES PROVIDERS


EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2007, LOUISIANA MEDICAID REIMBURSES FOR INPATIENT CONCURRENT CARE FOR ADULTS. INPATIENT CONCURRENT CARE IS DEFINED AS THE PROVISION OF SERVICES BY MORE THAN ONE PHYSICIAN TO A PATIENT ON THE SAME DAY. LOUISIANA MEDICAID WILL REIMBURSE UP TO THREE MEDICALLY NECESSARY HOSPITAL INPATIENT SERVICE VISITS PER DAY FOR ADULT RECIPIENTS (AGED 21 YEARS AND OLDER), FOR PROVIDERS OF DIFFERENT SPECIALTIES/SUBSPECIALTIES. PROVIDERS ARE RESPONSIBLE FOR ADHERENCE TO THE INPATIENT CONCURRENT CARE (ADULT) POLICY WHICH IS LOCATED ON THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM USING THE APPROPRIATE LINK & WILL BE PUBLISHED IN LOUISIANA MEDICAID PROVIDER UPDATE. ANY NEW OR PREVIOUSLY DENIED CLAIMS (DENIAL DUE TO DAILY LIMIT EXCEEDED) FOR INPATIENT SERVICES MAY BE RESUBMITTED EITHER ELECTRONICALLY OR HARDCOPY.

ATTENTION INDIVIDUAL PROFESSIONAL SERVICES PROVIDERS


RE: SPECIALTY/SUBSPECIALTY UPDATE


TO ALLOW APPROPRIATE CLAIMS PROCESSING WHEN REIMBURSEMENT IS BASED ON SPECIALTY/SUBSPECIALTY, INDIVIDUAL PROVIDERS ARE ENCOURAGED TO CONFIRM THAT THEIR MEDICAID PROVIDER FILE ACCURATELY REFLECTS THEIR SPECIALTY/SUBSPECIALTY. IF CHANGES ARE REQUIRED, THE PROVIDER ENROLLMENT SPECIALTY CHANGE FORM CAN BE ACCESSED ON-LINE AT WWW.LAMEDICAID.COM, USING LINKS: 'PROVIDER ENROLLMENT' & 'FORMS TO UPDATE EXISTING PROVIDER INFORMATION', RESPECTIVELY. COMPLETED FORMS ARE TO BE MAILED AS DIRECTED TO: UNISYS PROVIDER ENROLLMENT, PO BOX 80159, BATON ROUGE, LA 70898-0159

ATTENTION PROVIDERS


DUE TO NEW CLAIMS PROCESSING GUIDELINES, LA MEDICAID WILL NO LONGER BE ABLE TO BILL MEDICARE DIRECTLY WHEN RECIPIENTS ARE MEDICARE ELIGIBLE & MEDICAID HAS ALREADY PAID THE CLAIM. RECENTLY, THE IDENTIFICATION OF AN ERROR IN OUR CLAIMS PROCESSING LOGIC CAUSED SOME PROVIDERS TO RECEIVE A RECOUPMENT LETTER. MANY OF THESE PROVIDERS QUICKLY NOTIFIED US OF THIS PROBLEM, AND WE WERE ABLE TO IDENTIFY THE ERROR AND CORRECT THE PROGRAMMING BEFORE ANY MONIES WERE ERRONEOUSLY RECOUPED. WE APPRECIATE THE SPEEDY ACTION BY THE PROVIDER COMMUNITY AND ARE PLEASED THAT NO UNNECESSARY RECOUPMENTS WERE MADE. UNISYS HAS TAKEN CORRECTIVE ACTION TO PREVENT THIS FROM HAPPENING IN THE FUTURE. WE APOLOGIZE FOR THE ERROR.