RA Messages for December 8, 2009

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.

Detailed LMAC and FUL changes are posted on www.lamedicaid.com.

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. 

NOTICE TO PROVIDERS OF HOSPICE SERVICES

When a recipient revokes or is discharged alive during an election period, the recipient loses any remaining days in the election period. Louisiana Register Vol. 28, No. 26, June 20, 2002, Chapter 35, Section 3501-F.

ATTENTION PROVIDERS

It is the intent of LA Medicaid to employ nationally recognized methods to improve claims processing accuracy and consistency. With that goal in mind, LA Medicaid is pleased to announce the planned implementation of the McKesson 'ClaimCheck' claims editing product and the provider reference tool known as 'Clear Claim Connection'. These products will supplement our current claims processing system, especially as related to professional and outpatient hospital claims. Preparations for this implementation are underway with an anticipated effective date of processing claims using 'ClaimCheck' of mid-May 2010. Please visit the LA Medicaid web site, www.lamedicaid.com, using the 'ClaimCheck' link to view the intial web notice and for ongoing updates on this project.

ATTENTION PHARMACY PROVIDERS

Updates to the Pharmacy Benefits Management Services Manual are now available on the Louisiana Medicaid website at www.lamedicaid.com. Pharmacy providers should refer to the manual for a complete description of Medicaid pharmacy program policy.

ATTENTION LAB & RADIOLOGY (NON-HOSPITAL) PROVIDERS
IMPLEMENTATION OF REIMBURSEMENT RATE REDUCTIONS

Effective with dates of service on or after August 4, 2009, the reimbursement rates for laboratory and radiology services are reduced by 4.7% of the fee amounts on file as of August 3, 2009. An emergency rule regarding these reductions was published in the August 20, 2009, issue of the Louisiana Register. Please refer to the emergency rule section of the August 2009 Louisiana Register on the Office of the State Register's website at http://doa.louisiana.gov/osr/. Providers will begin seeing these reductions on the RA of December 8, 2009. For fees in effect for date of service August 4, 2009, and forward, providers should refer to the interim fee schedule posted on the homepage of the LA Medicaid website (www.lamedicaid.com) under the link entitled "Lab & Radiology (Non-Hospital) Rate Reductions" and not the Professional Services fee schedule. Claims for date of service August 4, 2009, that were adjudicated prior to December 8, 2009, will be systematically adjusted and no action is required by providers. Providers should monitor future RAs for updates regarding these adjustments. Notification will be made via remittance advice message when the recycle occurs.

ATTENTION PROVIDERS

The 2009 holiday EDI processing schedule will be as follows:

Thanksgiving Wed. Nov25 at 10:00AM
Christmas Wed. Dec23 at 10:00AM
New Year Thurs. Dec31 at 10:00AM

*NO extension will be given

ATTENTION LTC PROVIDERS
CHANGES TO THE 148 PLI ADJUSTMENT PROCEDURE

Effective December 1, 2009, all 148 PLI Adjustment Forms may only be completed and submitted to Unisys for processing by a BHSF representative. Providers may no longer complete and/or submit these forms for processing. The 148 PLI Adjustment Form is being revised to reflect these changes, and forms may no longer be obtained through Unisys. Providers should contact the recipient's Parish Medicaid Office if they have information or concerns about patient liability.

MPORTANT NOTICE TO ALL MEDICAID PROVIDERS AND VENDORS

Due to a shortage of Louisiana Medicaid 7-digit provider numbers to enroll new providers, we will increase the availability of these numbers for assignment to newly enrolled providers by using numbers that being with "2" as the first digit of the number. Beginning December 4, 2009, LA Medicaid will convert all systems to accept 7-digit provider numbers beginning with "2". LA Medicaid provider numbers beginning with "1" will continue to be valid and accepted. Please see the homepage at our website, www.lamedicaid.com, for additional information and continue to watch RA messages and the website for definite dates of this conversion.

ATTENTION PHARMACY PROVIDERS
LOUISIANA MEDICAID REIMBURSEMENT OF TAMIFLU� SUSPENSION

Louisiana Medicaid does not pay for compounded prescriptions, nor has the billing process been established to allow the submission of compounded prescriptions.

Due to H1N1 Declared Emergency and shortage of commercially manufactured oseltamivir (Tamiflu�) suspension, Louisiana Medicaid will only allow pharmacies to bill the quantity of Tamiflu� capsules utilized in the mixing of the suspension as ordered by a prescribing practitioner's prescription. This will be allowed as long as the shortage of the manufactured Tamiflu� exists.

Pharmacies may receive letters from the Louisiana Medicaid Pharmacy Audit Section which is verifying the quantity of Tamiflu� capsules dispensed. In some instances, pharmacies have submitted billed quantities for the final compounded quantity and not the total number of capsules used in the mixing of the suspension. Following the instructions above will avoid the overbilling of quantities and/or charges.

When a pharmacy is attempting to bill Medicaid as the secondary payor, the claim must be submitted on the NCPDP paper Universal Claim Form.

For those pharmacy providers who have a Memorandum of Understanding with the Louisiana Department of Health and Hospitals' Office of Public Health to dispense antivirals from the Strategic National Stockpile, please be reminded that Medicaid may not be billed for these prescriptions.