RA Messages for November 14, 2005
PHARMACY PROVIDERS, PLEASE NOTE!!!
PLEASE
MAKE THE FOLLOWING CHANGES TO APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| BRIMONIDINE TARTRATE |
SOL/DROPS,OPH |
0.2% |
$4.50000 |
11/12/05 |
| CEFUROXIME AXETIL |
TAB |
250MG |
$2.54250 |
11/12/05 |
| CEFUROXIME AXETIL |
TAB |
500MG |
$4.74750 |
11/12/05 |
| CILOSTAZOL |
TAB |
100MG |
$1.03880 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
25MG |
$0.05760 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
50MG |
$0.08280 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
75MG |
$1.03040 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
100MG |
$1.35390 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
150MG |
$1.96170 |
11/12/05 |
| FOLIC ACID |
TAB |
1MG |
$0.28580 |
11/12/05 |
| GENTAMICIN SULFATE |
TOP CR 15GM |
1% |
$0.20000 |
11/12/05 |
| GENTAMICIN SULFATE |
TOP OINT 15GM |
1% |
$0.20000 |
11/12/05 |
| METRONIDAZOLE |
TOP CR 45GM |
0.75% |
$1.62630 |
11/12/05 |
| MOMETASONE FUROATE |
TOP OINT 45GM |
0.1% |
$0.93330 |
11/12/05 |
| NYSTATIN |
TOP POWDER 15GM |
100,000U |
$1.74800 |
11/12/05 |
| OXYBUTYNIN CHLORIDE |
SYRUP 473ML |
5MG/ML |
$0.08250 |
11/12/05 |
| PHENYTOIN |
OR SUSP 237ML |
125MG/5ML |
$0.15210 |
11/12/05 |
| POTASSIUM CHLORIDE |
EXT REL TAB |
10MEQ |
$0.25380 |
11/12/05 |
| POTASSIUM CHLORIDE |
EXT REL TAB |
20MEQ |
$0.46250 |
11/12/05 |
| PYRIDOSTIGMINE BROMIDE |
TAB |
60MG |
$0.58320 |
11/12/05 |
| RIFAMPIN |
CAP |
300MG |
$1.88600 |
11/12/05 |
| TERAZOSIN HCL |
CAP |
1MG |
$0.60000 |
11/12/05 |
| TERAZOSIN HCL |
CAP |
2MG |
$0.60000 |
11/12/05 |
| TERAZOSIN HCL |
CAP |
5MG |
$0.60000 |
11/12/05 |
| TERAZOSIN HCL |
CAP |
10MG |
$0.60000 |
11/12/05 |
| TORSEMIDE |
TAB |
100MG |
$2.91750 |
11/12/05 |
| TRIMETHPBENZAMIDE
HCL |
CAP |
300MG |
$1.01930 |
11/12/05 |
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
PHYSICIAN ASSISTANT CLAIMS
EFFECTIVE IMMEDIATELY, PROVIDERS MAY SUBMIT CLAIMS FOR SERVICES
PERFORMED BY PHYSICIAN ASSISTANTS (PA) FOR DATES OF SERVICE JULY 1, 2005 FORWARD. THIS INCLUDES CLAIMS THAT HAVE BEEN HELD AWAITING THIS
IMPLEMENTATION. MEDICAID REQUIRES THAT PA'S ENROLL AND ALL SERVICES THEY PROVIDE BE BILLED IDENTIFYING THE PA AS THE ATTENDING PROVIDER. SEE THE
MARCH/APRIL 2005 "LOUISIANA MEDICAID PROVIDER UPDATE" FOR ADDITIONAL INFORMATION.
CERTIFIED NURSE PRACTITIONER, CLINICAL NURSE
SPECIALIST
AND CERTIFIED NURSE MIDWIFE CLAIMS
EFFECTIVE IMMEDIATELY, PROVIDERS MAY SUBMIT CLAIMS FOR SERVICES PERFORMED
BY CNP'S, CNS'S AND CNM'S FOR DATES OF SERVICE AUGUST 1, 2005 FORWARD. THIS INCLUDES THOSE CLAIMS THAT HAVE BEEN HELD AWAITING THIS
NOTIFICATION. MEDICAID IMPLEMENTED CHANGES IN REIMBURSEMENT METHODOLOGY FROM A "LIST" OF BILLABLE SERVICES, TO COVERAGE DETERMINED BY LICENSURE
AND SCOPE OF PRACTICE, EFFECTIVE WITH DATE OF SERVICE AUGUST 1, 2005. MEDICAID REQUIRES THAT ALL SERVICES PERFORMED BY THESE PROVIDERS BE
BILLED IDENTIFYING THE CNP, CNS, OR CNM AS THE ATTENDING PROVIDER. SEE THE MARCH/APRIL 2005
"LOUISIANA MEDICAID PROVIDER UPDATE" FOR ADDITIONAL INFORMATION.
NOTICE TO ACUTE CARE HOSPITAL PROVIDERS
EFFECTIVE FOR DATES OF SERVICE ON OR AFTER NOVEMBER 1,2005, ALL POLICIES
IN EFFECT REGARDING PRIOR AUTHORIZATION AND PRE-CERTIFICATION WILL ONCE
AGAIN BE ENFORCED. THIS INCLUDES THOSE WAIVERS IN PLACE DUE TO HURRICANE
KATRINA.
OUT OF STATE HOSPITALS NOT IN THE TRADE AREA ARE REQUIRED TO OBTAIN
PRIOR AUTHORIZATION FOR INPATIENT ADMITS NOT OF AN EMERGENCY NATURE BY
CONTACTING THE PRIOR AUTHORIZATION UNIT AT 1-800-488-6334. APPROVAL MAY
ONLY BE GRANTED FOR THOSE SERVICES NOT PROVIDED WITHIN THE STATE.
OUT OF STATE PSYCHIATRIC INPATIENT STAYS ARE ONLY APPROVED FOR 2 (TWO)
DAYS STABILIZATION AND THEN MUST BE RETURNED TO A LOUISIANA FACILITY IF
FURTHER TREATMENT IS MEDICALLY NECESSARY.
ATTENTION ANESTHESIA PROVIDERS
LOUISIANA MEDICAID IDENTIFIED A PROGRAMMING PROBLEM WITH CPT CODE 01961
(ANESTHESIA FOR CESAREAN DELIVERY ONLY) WHICH BEGAN IN MAY 2005. THE
PROGRAMMING HAS BEEN UPDATED AND CLAIMS SUBMITTED AFTER SEPTEMBER 14,
2005, HAVE PROCESSED CORRECTLY. THE CLAIMS THAT ORIGINALLY PROCESSED
INCORRECTLY PRIOR TO SEPTEMBER HAVE BEEN RECYCLED ON THE 10/25/2005 RA.
ATTENTION PROFESSIONAL SERVICES PROVIDERS
EFFECTIVE WITH DATE OF SERVICE DECEMBER 1, 2005, LOUISIANA MEDICAID WILL
ADOPT CPT GUIDELINES AS THESE GUIDELINES RELATE TO MODIFIER 51.PROVIDERS
WILL NO LONGER BE REQUIRED TO APPEND A 51 MODIFIER TO AN ADD-ON CODE OR
A MODIFIER 51 EXEMPT CODE. ALL SURGICAL PROCEDURES THAT ARE NOT
IDENTIFIED AS MODIFIER 51 EXEMPT WILL BE REIMBURSED BASED ON MULTIPLE
SURGERY POLICY.
IF A 51 MODIFIER IS APPENDED INCORRECTLY, THE CLAIM LINE WILL DENY WITH
ERROR CODE 781, "MODIFIER NOT CORRECT." IF A 51 MODIFIER IS REQUIRED AND
NOT APPENDED, THE CLAIM LINE WILL DENY WITH ERROR CODE 973, "NO SURGERY
MODIFIER."