IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT THE PBM HELP DESK AT 1-800-648-0790.

PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX B:

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 PHYSICIANS

DENIALS OF PHYSICIAN CLAIMS FOR INPATIENT HOSPITAL CARE ARE FREQUENTLY DUE TO PHYSICAN SERVICES BEING RENDERED BEYOND THE NUMBER OF DAYS FOR WHICH THE HOSPITAL OBTAINED PRECERTIFICATION. PLEASE SEE THE "PRECERTI- FICATION POLICY CLARIFICATION FOR PHYSICIANS" ARTICLE IN THE NEXT ISSUE OF THE LOUISIANA MEDICAID PROVIDER UPDATE, OR REFER TO THE PRECERTIFICA- TION POLICY IN THE 2006 LOUISIANA MEDICAID PROFESSIONAL SERVICES PROVIDER TRAINING MANUAL, PAGES 70-71.

ATTENTION DENTAL PROVIDERS

2006 AMERICAN DENTAL ASSOCIATION CLAIM FORM (HARDCOPY)

IN THE NEAR FUTURE, MEDICAID WILL BEGIN ACCEPTING THE NEW 2006 AMERICAN DENTAL ASSOCIATION (ADA) CLAIM FORM FROM PROVIDERS WHO SUBMIT HARDCOPY CLAIMS TO MEDICAID FOR PRIOR AUTHORIZATION AND PAYMENT OF DENTAL SERVICES. THE EFFICTIVE DATE FOR ACCEPTANCE OF THE 2006 ADA CLAIM FORM BY MEDICAID WILL BE PROVIDED AS SOON AS POSSIBLE. ADDITIONAL IMPORTANT INFORMATION ON THIS TOPIC IS LOCATED ON THE FOLLOWING WEBSITE: WWW.LAMEDICAID.COM (GO TO LINK ENTITLED "NEW MEDICAID INFORMATION" OR "BILLING INFORMATION"). PROVIDERS SHOULD CHECK THIS WEBSITE PERIODICALLY FOR NEW UPDATES ON THIS TOPIC.

LEVEL OF CARE ELIGIBILITY TOOL (LOCET) IMPLEMENTATION UPDATE

THE DEPARTMENT OF HEALTH AND HOSPITALS (DHH), OFFICE OF AGING AND ADULT SERVICES (OAAS) WILL IMPLEMENT A NEW TOOL TO ASSURE THAT INDIVIDUALS MEET THE MEDICAL NECESSITY REQUIREMENTS FOR ADMISSION TO AND CONTINUED STAY IN ANY LONG TERM CARE PROGRAM WHICH REQUIRES A NURSING FACILITY LEVEL OF CARE. IMPLEMENTATION OF THE LEVEL OF CARE ELIGIBILITY TOOL (LOCET) WILL BE EFFECTIVE 12/1/2006. PROVIDERS ARE ENCOURAGED TO VISIT THE OAAS WEBSITE AT HTTP://WWW.LTSS.DHH.LOUISIANA.GOV (CLICK ON "LOCET IMPLEMENTATION UPDATE") TO OBTAIN MORE INFORMATION ABOUT THIS NEW PROCESS.

ATTENTION 1500 AND UB PROVIDERS

THE OFFICE OF MANAGEMENT AND BUDGET (OMB), THE NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) AND THE NATIONAL UNIFORM BILLING COMMITTEE (NUBC) HAVE GIVEN THEIR STAMP OF APPROVAL TO THE NEW 1500 HEALTH INSURANCE CLAIM FORM (VERSION 08/05) AND THE NEW UB-04 CLAIM FORM. THE LOGISTICS FOR DISTRIBUTION AND TRANSITION TO THESE REVISED FORMS, INCLUDING EFFECTIVE DATES FOR USE BY PROVIDERS AND ACCEPTANCE BY PAYERS, IS UNDER REVIEW BY THE COMMITTEES. IT IS VERY IMPORTANT THAT YOU DO NOT BEGIN USING THESE NEW FORMS FOR LA MEDICAID BILLING UNTIL YOU ARE INFORMED OF THE EFFECTIVE DATE OF THE TRANSITION FOR LA MEDICAID CLAIMS PROCESSING. YOU WILL BE KEPT INFORMED OF ALL NECESSARY INFORMATION FOR IMPLEMENTING THESE FORMS FOR LA MEDICAID BILLING THROUGH RA MESSAGES, NEWSLETTER ARTICLES, AND PROVIDER NOTICES POSTED ON OUR WEB SITE WWW.LAMEDICAID.COM . PLEASE WATCH THESE INFORMATION AVENUES FOR THE MOST UP-TO-DATE INFORMATION FOR BILLING LA MEDICAID.

NATIONAL PROVIDER IDENTIFIER

DHH HAS LAUNCHED A NEW NPI WEB REGISTRATION SITE FOR PROVIDERS TO REGISTER THEIR NPI WITH LOUISIANA MEDICAID. CMS WILL REQUIRE ALL HIPAA STANDARD TRANSACTIONS, INCLUDING MEVS ELIGIBILITY INQUIRY AND CLAIMS STATUS INQUIRY TO BE SUBMITTED USING THE NPI NUMBER BEGINNING 23-MAY-07. THE NEW NPI APPLICATION IS ACCESSIBLE FROM THE LIST OF APPLICATIONS IN THE SECURED PROVIDER AREA OF THE WWW.LAMEDICAID.COM WEB SITE. FIND THIS AND MORE ON THE NPI INFORMATION PAGE ACCESSIBLE FROM WWW.LAMEDICAID.COM >HIPAA INFORMATION CENTER>NATIONAL PROVIDER IDENTIFIER (NPI).