RA Messages for November 4, 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.
DRUG
DOSE STRGTH FUL EFF
ALLOPURINOL
TABLET 100MG $0.07850 11/28/08
ALLOPURINOL
TABLET 300MG $0.17390 11/28/08
BACLOFEN
TABLET 10MG $0.05250 11/28/08
BACLOFEN
TABLET 20MG $0.08930 11/28/08
CAPTOPRIL
TABLET 12.5MG $0.02330 11/28/08
CAPTOPRIL
TABLET 25MG $0.02630 11/28/08
CHLORDIAZEPOXIDE HCL
CAPSULE 5MG $0.11390 11/28/08
CHLORDIAZEPOXIDE HCL
CAPSULE 10MG $0.08780 11/28/08
CHLORDIAZEPOXIDE HCL
CAPSULE 25MG $0.09900 11/28/08
CIMETIDINE
TABLET 400MG $0.15480 11/28/08
CLORAZEPATE DIPOTASSIUM TABLET
3.75MG $0.13770 11/28/08
CLORAZEPATE DIPOTASSIUM TABLET
7.5MG $0.19470 11/28/08
CLORAZEPATE DIPOTASSIUM TABLET
15MG $0.27540 11/28/08
DIPHENOXYLATE HCL/ATROP TABLET
2.5MG-.025MG $0.21380 11/28/08
ENALAPRIL MALEATE
TABLET 2.5MG $0.04730 11/28/08
ENALAPRIL MALEATE
TABLET 5MG $0.05700 11/28/08
ENALAPRIL MALEATE
TABLET 10MG $0.07320 11/28/08
ENALAPRIL MALEATE
TABLET 20MG $0.08550 11/28/08
FLUOCINONIDE
CREAM(GM) 0.05% $0.11870 11/28/08
FLUOCINONIDE
SOLUTION 0.05% $0.26400 11/28/08
FOLIC
ACID
TABLET 1MG $0.03780 11/28/08
GABAPENTIN
CAPSULE 100MG $0.08250 11/28/08
GABAPENTIN
CAPSULE 300MG $0.12380 11/28/08
GABAPENTIN
CAPSULE 400MG $0.15180 11/28/08
HYDROCODONE BIT/ACET SOLUTION
7.5-500/15 $.10140 11/28/08
HYDROCODONE BIT/ACET
TABLET 5MG-500MG $0.47630 11/28/08
HYDROCODONE BIT/ACET
TABLET 7.5MG-500MG $0.64260 11/28/08
HYDROCODONE BIT/ACET
TABLET 10MG-500MG $0.51290 11/28/08
HYDROCODONE BIT/ACET
TABLET 7.5MG-650MG $0.67080 11/28/08
HYDROCODONE BIT/ACET
TABLET 10MG-660MG $0.54000 11/28/08
HYDROCODONE BIT/ACET
TABLET 7.5MG-750MG $0.15480 11/28/08
ISOSORBIDE DINITRATE
TABLET 5MG $0.04880 11/28/08
ISOSORBIDE DINITRATE
TABLET 10MG $0.05250 11/28/08
ISOSORBIDE DINITRATE
TABLET 20MG $0.05630 11/28/08
LIDOCAINE HCL
SOLUTION 2% $0.05130 11/28/08
LISINOPRIL
TABLET 2.5MG $0.03680 11/28/08
LISINOPRIL
TABLET 5MG $0.04830 11/28/08
LISINOPRIL
TABLET 10MG $0.06750 11/28/08
LISINOPRIL
TABLET 20MG $0.07950 11/28/08
LISINOPRIL
TABLET 30MG $0.16310 11/28/08
LISINOPRIL
TABLET 40MG $0.15000 11/28/08
LORAZEPAM
TABLET 0.5MG $0.07400 11/28/08
LORAZEPAM
TABLET 1MG $0.08220 11/28/08
LORAZEPAM
TABLET 2MG $0.14670 11/28/08
MECLIZINE HCL
TABLET 25MG $0.07790 11/28/08
METHOCARBAMOL
TABLET 500MG $0.19430 11/28/08
METHOCARBAMOL
TABLET 750MG $0.25200 11/28/08
METHYLPREDNISOLONE
TABLET 4MG $0.43040 11/28/08
OXYCODONE HCL/ACET
CAPSULE 5MG-500MG $0.32300 11/28/08
OXYCODONE HCL/ACET
TABLET 5MG-325MG $0.23400 11/28/08
PAROXETINE HCL
TABLET 10MG $0.34250 11/28/08
PAROXETINE HCL
TABLET 20MG $0.35750 11/28/08
PAROXETINE HCL
TABLET 30MG $0.42000 11/28/08
PAROXETINE HCL
TABLET 40MG $0.48750 11/28/08
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 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.
ATTENTION PHARMACY PROVIDERS
Updates to the Pharmacy
Benefits Management Services Manual are now available on the Louisiana
Medicaid web site at www.lamedicaid.com. Pharmacy providers should refer
to the manual for a complete description of Medicaid pharmacy program
policy.
ATTENTION DENTAL PROVIDERS
Dental policy changes in
regards to the EPSDT Dental codes D9230, D9248, and D9920 went into
effect on October 7, 2008. Complete details are placed on the
www.lamedicaid.com web site under the "New Medicaid Information" and
"Billing Information" links. If you have questions, you may contact the
LSU Dental Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free).
ATTENTION PHYSICIANS/CLINICS
As a result of Hurricane
Gustav we implemented logic to bypass various edits, including some
service limit edits, for dates of service August 27th through September
30th. One of those edits, Edit 907 (Physician/Clinic Visits Exceeded)
was not bypassed correctly for the affected dates of service. Claims
that were denied because of this have been identified and will be
recycled for correct payment in the 11/04/08 RA. No action is required
by providers.
ATTENTION HOSPITAL PROVIDERS
You were notified in the
2007 Louisiana Medicaid Hospital Provider Training packet that only 1
revenue code 450 or 459 may be used per emergency room visit. Providers
have continued to inappropriately bill multiple revenue codes 450 and
459. As a result, programming logic has been implemented recently to
deny claims billed with these multiple codes. One revenue code 450 or
459 (as appropriate) should be billed and should be accompanied by the
correct, appropriate procedure code 99281-99285. Other procedure/HCPCS
codes are inappropriate. Providers billing multiple codes 450 and 459
are now receiving denial edit 114 (invalid/ missing HCPCS) for lines
displaying procedure codes other than 99281-99285, and denial edit 093
(revenue code missing/invalid) for the claim line displaying the correct
procedure codes 99281-99285. The 093 denial code is being changed to
reflect new denial code 113 (only 1 ER revenue 450-459 code per visit).
It is necessary for any provider billing multiple ER revenue codes and
receiving these details to resubmit the single, correct revenue code
line with the correct procedure/HCPCS code for consideration of payment.
Please discontinue this practice immediately!