RA Messages for November 1, 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
ATTENTION DENTAL PROVIDERS
EFFECTIVE NOVEMBER 1, 2005, CERTAIN DENTAL CODING, POLICY AND RELATED
FEE REVISIONS WILL APPLY. DETAILED INFORMATION RELATED TO THESE REVISIONS IS LOCATED AT THE FOLLOWING WEBSITE: WWW.LAMEDICAID.COM UNDER THE LINK
ENTITLED "NEW MEDICAID INFORMATION" AND UNDER THE HEADING OF "DENTAL PROVIDERS." IN ADDITION, THE REVISED FEE SCHEDULES FOR THE EPSDT DENTAL,
ADULT DENTURE AND EXPANDED DENTAL SERVICES FOR PREGNANT WOMEN PROGRAMS ARE ALSO AVAILABLE AT THE ABOVE-REFERENCED WEBSITE UNDER THE
LINK ENTITLED "FEE SCHEDULES." IF YOU DO NOT HAVE WEB ACCESS AND WISH TO REQUEST A HARDCOPY OF THE REVISED INFORMATION AND FEE SCHEDULES, YOU
SHOULD CONTACT UNISYS PROVIDER RELATIONS AS SOON AS POSSIBLE BY CALLING (225)924-5040 OR TOLL-FREE @ (800)473-2783.
ATTENTION PROVIDERS
THE 2006 ICD-9 DISEASE AND PROCEDURE CLASSIFICATION CODE UPDATE HAS BEEN
COMPLETED AND WILL BE EFFECTIVE WITH DATES OF SERVICE 10/01/2005. CLAIMS WITH INVALID CODES BEARING A 10/01/2005 OR LATER DATE OF SERVICE WILL
DENY.
IMPORTANT INFORMATION REGARDING COMMUNITYCARE
REFERRALS
THE COMMUNITYCARE REFERRAL AND KIDMED LINKAGE REQUIREMENTS WERE
TEMPORARILY WAIVED FOR RECIPIENTS FROM THE 13 PARISHES MOST DIRECTLY AFFECTED BY HURRICANE KATRINA. THOSE WAIVERS WILL END EFFECTIVE WITH DATES OF
SERVICE NOVEMBER 1, 2005, FOR ENROLLEES IN THE FOLLOWING PARISHES: ST. JAMES, LAFOURCHE, WASHINGTON, TANGIPAHOA, TERREBONNE, ST. CHARLES,
AND ST. JOHN. THIS MEANS THAT IF YOU PROVIDE MEDICAL CARE TO A COMMUNITYCARE RECIPIENT FROM ONE OF THE ABOVE PARISHES, ON OR AFTER NOVEMBER 1,
2005, AND YOU ARE NOT THE PCP PROVIDER OF RECORD, YOU WILL NEED A REFERRAL FROM THE PCP IN ORDER TO BE PAID BY MEDICAID. SERVICES PROVIDED
TO KIDMED ENROLLEES WHO ARE NOT IN COMMUNITYCARE MUST BE PROVIDED BY THE KIDMED PROVIDER OF RECORD. THE REQUIREMENT FOR A COMMUNITYCARE REFERRAL/KIDMED LINKAGE WAIVER WILL CONTINUE TO BE WAIVED FOR RECIPIENTS FROM
ORLEANS, ST. BERNARD, PLAQUEMINES, EAST JEFFERSON, WEST JEFFERSON AND ST. TAMMANY PARISHES UNTIL FURTHER NOTICE.
THE EFFECTIVE DATE OF THE WAIVER OF 60 DAYS TIMELY FILING OF KIDMED
CLAIMS HAS BEEN CHANGED FROM AUGUST 27, 2005 TO AUGUST 01, 2005. THE WAIVER WILL END EFFECTIVE WITH DATES OF SERVICE NOVEMBER 1, 2005 FOR ALL
PROVIDERS EXCEPT THOSE IN ORLEANS, WEST JEFFERSON, EAST JEFFERSON, ST. TAMMANY, ST. MARY, CAMERON, IBERIA, ST. BERNARD, PLAQUEMINES, CALCASIEU
AND VERMILLION PARISHES.
CHIROPRACTIC SERVICES CHANGE
PROCEDURE CODES 97260 AND 97261 HAVE BEEN DELETED IN THE 'CURRENT
PROCEDURAL TERMINOLOGY' MANUAL (CPT). EFFECTIVE WITH DATES OF SERVICE 9-1-05 FORWARD, CHIROPRACTORS SHOULD BILL FOR SERVICES USING THE CURRENT
APPROPRIATE CPT CODE (98940 OR 98941) FOR THE SERVICE PROVIDED. LOUISIANA MEDICAID'S NON-ENHANCED FEE FOR THESE CODES IS BASED ON 80% OF
THE 2005 MEDICARE ALLOWANCE. HCPCS MODIFIER 'AT' (ACUTE TREATMENT) MAY BE APPENDED. MEDICAID COVERAGE AND CRITERIA REGARDING THESE SERVICES HAS
NOT CHANGED. CLAIMS USING CPT CODES 97260 AND 97261 THAT DENY EFFECTIVE 9-1-05 SHOULD BE RESUBMITTED USING CURRENT CODES.