RA Messages for November 7, 2006
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 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. PARTI-
CIPATION MAY BE VERIFIED IN APPENDIX C, AVAILABLE AT WWW.LAMEDICAID.COM
ATTENTION ALL PROVIDERS
EFFECTIVE WITH DATES OF SERVICE OCTOBER 1, 2006 FORWARD, THE 2007 ICD-9
DISEASE AND PROCEDURE CLASSIFICATION CODE UPDATES HAVE BEEN ADDED TO OUR
FILES. CLAIMS THAT HAVE DENIED FOR INVALID DIAGNOSIS/PROCEDURE CODES
PRIOR TO THE LOADING OF THE 2007 ICD-9 DATA WILL BE RECYCLED AND NO
ACTION IS REQUIRED BY THE PROVIDER. PROVIDERS WILL BE INFORMED VIA RA
MESSAGE WHEN THE RECYCLE WILL TAKE PLACE.
ATTENTION ALL PROVIDERS-TIME SENSITIVE INFORMATION
LOUISIANA MEDICAID WILL ALLOW THE SUBMISSION/RESUBMISSION OF CLAIMS THAT
NORMALLY REQUIRE A HARD COPY ATTACHMENT TO BE CONSIDERED FOR REIMBURSEMENT WHERE THE ATTACHMENT WAS DESTROYED BY THE EFFECTS OF HURRICANE
KATRINA OR RITA. THIS CONSIDERATION APPLIES ONLY TO CLAIMS THAT REQUIRE
AN ATTACHMENT FOR NORMAL PROCESSING. DETAILS OF CLAIMS SUBMISSIONS AND
ATTESTATION REQUIREMENTS AS WELL AS GENERAL INSTRUCTIONS CAN BE FOUND
ON THE LOUISIANA MEDICAID WEBSITE AT
WWW.LAMEDICAID.COM USING THE
HURRICANE KATRINA/RITA INFORMATION LINK. ONLY THOSE PROVIDERS WITHOUT
INTERNET ACCESS SHOULD CALL UNISYS PROVIDER RELATIONS FOR THIS INFORMATION AT 800-473-2738 OR 225-924-5040. NO CLAIMS WILL BE ACCEPTED AFTER
DECEMBER 29, 2006.
ATTENTION MENTAL HEALTH CLINIC PROVIDERS
PROCEDURE CODE 90782 FOR INJECTIONS WILL BE OBSOLETE EFFECTIVE 11/1/06.
FOR DATES OF SERVICE BEGINNING 11/1/06, PLEASE BILL CODE 90772.
ATTENTION MENTAL HEALTH REHABILITATION PROVIDERS
PROCEDURE CODE 90782 FOR INJECTIONS HAS BEEN MADE OBSOLETE. FOR PRIOR
AUTHORIZATION REQUESTS BEGINNING 10/1/06 AND EXTENDING BEYOND 12/31/06,
THE AUTHORIZATIONS FOR CODE 90782 WILL BE CANCELLED AND REISSUED IN CODE
90772. YOU MAY CONTINUE TO BILL 90782 FOR SERVICE AUTHORIZATION PERIODS
WHICH BEGAN PRIOR TO 10/1/06 AND END 12/31/06 OR BEFORE.
ATTENTION PSYCHOLOGICAL AND BEHAVIORAL SERVICES PROVIDERS
PROCEDURE CODE 96100 FOR PSYCHOLOGICAL TESTING IS OBSOLETE EFFECTIVE
11/1/06. BEGINNING 11/1/06 BILL CODE 96101 PSYCHOLOGICAL TESTING BY
PSYCHOLOGIST OR PHYSICIAN. THE RATE FOR THIS PROCEDURE HAS BEEN IN-
CREASED TO $74.69 PER UNIT UP TO A MAXIMUM OF 8 UNITS. ONLY ONE PROCE-
DURE PER RECIPIENT PER YEAR MAY BE BILLED BY A PROVIDER/GROUP.
ATTENTION DENTAL PROVIDERS
EFFECTIVE 11/1/06, CERTAIN SERVICES IN THE EPSDT DENTAL, ADULT DENTURE
AND EXPANDED DENTAL SERVICES FOR PREGNANT WOMEN PROGRAMS WILL RECEIVE
RATE INCREASES. ALSO, SEVERAL ADDITIONAL SERVICES WILL BE MADE PAYABLE
AND POLICY REVISIONS RELATED TO SEVERAL EXISTING DENTAL SERVICES WILL
OCCUR. COMPLETE INFORMATION REGARDING THE RATE INCREASES, NEW ADDITIONAL
CODES AND POLICY REVISIONS WILL BE PLACED ON THE FOLLOWING WEBSITE PRIOR
TO 11/1/06:
WWW.LAMEDICAID.COM (LINKS ENTITLED "NEW MEDICAID INFORMATION"
"BILLING INFORMATION" AND "FEE SCHEDULES.") MEDICAID WILL WORK DILIGENTLY TO ENSURE THAT ALL CHANGES ARE IN PLACE BY 11/1/06. HOWEVER, IN
THE EVENT THAT A DELAY IS UNAVOIDABLE, WE REMIND YOU THAT DENTAL PROVIDERS ARE REQUIRED BY MEDICAID TO BILL THEIR USUAL AND CUSTOMARY FEES.
PROVIDERS WHO BILL THEIR USUAL AND CUSTOMARY FEELS WILL NOT BE REQUIRED
TO MANUALLY ADJUST THEIR CLAIMS SHOULD A CLAIM RECYCLE BE REQUIRED AS
MEDICAID WILL AUTOMATICALLY ADJUST THE CLAIMS. IF A DENTAL PROVIDER DOES
NOT BILL THEIR USUAL AND CUSTOMARY FEES AND A CLAIM RECYCLE IS REQUIRED,
THE DENTAL PROVIDER WILL BE RESPONSIBLE FOR ALL NECESSARY CLAIM ADJUSTMENTS. SHOULD YOU HAVE ANY QUESTIONS RELATED TO THIS MATTER, YOU MAY
CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR
(225)924-5040.