RA Messages for November 9, 2011

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. Participation may be verified in Appendix C, available at www.lamedicaid.com. 

ATTENTION PHARMACY PROVIDERS

New this influenza season is the Fluzone� intradermal vaccine, which is indicated for ages eighteen to sixty-four. This vaccine is not provided by the Louisiana Vaccines for Children (VFC) program this season. Therefore, Medicaid will reimburse pharmacy providers the cost of the vaccine and its administration when given to recipients who are ages eighteen through sixty-four.

Reimbursement by Medicaid of this influenza vaccine and administration is limited to the following fees:  

Vaccine Maximum Vaccine Reimbursement Maximum Administration Fee Reimbursement
Influenza Vaccine, Intradermal $18.38 $15.22

Please click the link for Pharmacy & Prescribing Providers link, and then the Influenza link, and see the 2011-2012 Influenza Season section for detailed policy, reimbursement, and billing information.

ATTENTION PROFESSIONAL SERVICE PROVIDERS

The Department is pleased to inform providers, effective November 1, 2011, the list of diagnosis codes reimbursable for Hyperbaric Oxygen Therapy has been updated. The diagnosis codes for the following conditions will now be reimbursable as follows:

Acute carbon monoxide intoxication,
Acute peripheral arterial insufficiency,
Acute traumatic peripheral ischemia,
Chronic refractory osteomyelitis unresponsive to conventional
treatment,
Crush injuries and suturing of severed limbs,
Decompression illness,
Diabetic wounds of the lower extremities,
Gas embolism,
Gas gangrene,
Osteoradionecrosis as an adjunct to conventional treatment,
Preparation and preservation of compromised skin grafts,
Progressive necrotizing infections,
Soft tissue radionecrosis as an adjunct to conventional treatment.

Providers should contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with billing or policy questions.

LAPOST DOCUMENT TO AID IN END-OF-LIFE CARE PLANNING

Baton Rouge, La. - The LaPOST document, recently given final approval by the Louisiana Legislature, is now available as a physician resource when helping patients plan and state their end-of-life treatment preferences and goals of care. LaPOST, which stands for Louisiana Physician Order for Scope of Treatment, specifies patients' wishes in the event they are unable to communicate. It is a physician order and is only recommended for patients with a life-limiting illness and a life expectancy of less than one year. Physicians and their patients must complete and sign the LaPOST document for it to be valid. More information is available at www.lhcqf.org.

COMMUNITY CHOICES WAIVER PERSONAL ASSISTANCE SERVICES CLAIMS DENIALS

Claims for some Community Choices Waiver services were denied in error. Logic has been put in place and claims are being recycled. You do not have to resubmit.

ATTENTION PROFESSIONAL SERVICE PROVIDERS
ANESTHESIA POLICY

Louisiana Medicaid has received multiple inquiries related to the denied reimbursement of claims specific to Pain Management. Louisiana Medicaid Pain Management policy states:

"Epidurals administered for the prevention or control of acute pain, such as that which occurs during delivery or surgery, are covered by the Professional Services Program for this purpose only. Epidurals given to alleviate chronic, intractable pain are not covered."

Therefore, epidurals or nerve block anesthesia administered to a recipient following a surgical related procedure for the prevention on management of postoperative pain will not be reimbursed.