PHARMACY PROVIDERS, PLEASE NOTE!!! 

PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX A:  

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 PHARMACISTS AND PRESCRIBING PROVIDERS

EFFECTIVE NOVEMBER 22, 2005, THE LMPBM UNIT BEGAN REIMBURSING FOR SILDENAFIL (REVATIO) WHEN AN APPROPRIATE DIAGNOSIS CODE IS SUBMITTED ON THE POS CLAIM.  THE PRESCRIBING PROVIDER MUST DOCUMENT THE DIAGNOSIS CODE ON THE HARDCOPY PRESCRIPTION OR CAN COMMUNICATE THE DIAGNOSIS CODE OVER THE PHONE. THE ACCEPTABLE DIAGNOSIS CODES ARE:   

416.0-PRIMARY PULMONARY HYPERTENSION
416.8-OTHER CHRONIC PULMONARY HEART DISEASE                          

A DETAILED LETTER WILL FOLLOW IN THE MAIL. ALL NEW PRESCRIPTIONS FOR SYMBYAX (OLANZAPINE/FLUOXETINE) WILL REQUIRE AN APPROPRIATE ICD-9-CM DIAGNOSIS CODE WRITTEN ON THE HARDCOPY PRESCRIPTION AND BILLED THROUGH POS. THE ACCEPTED DIAGNOSIS CODES FALL IN THE RANGE FROM 290.0 THROUGH 319.9

2005 CHRISTMAS/NEW YEAR HOLIDAY CLAIMS CUT-OFF SCHEDULE

THE FOLLOWING IS THE 2005 CHRISTMAS/NEW YEAR HOLIDAY CUT-OFF SCHEDULE FOR THE SUBMISSION OF ALL HIPAA COMPLIANT CLAIMS: 

CHRISTMAS/NEW YEAR - THE CUT-OFF FOR KIDMED TRANSMISSIONS WILL BE WEDNESDAY 12/21/05 (CHRISTMAS) AND 12/28/05 (NEW YEAR) AT 4:30 PM. ALL DISKETTES AND CDS MUST BE IN OUR OFFICE NO LATER THAN 5:00 PM WEDNESDAY, 12/21/05 (CHRISTMAS) AND 12/28/05 (NEW YEAR). ALL TELECOMMUNICATED FILES MUST REACH US NO LATER THAN 10:00 AM THURSDAY 12/22/05 (CHRISTMAS) AND 12/29/05 (NEW YEAR). EXTENSIONS BEYOND THE CUT-OFF WILL NOT BE GRANTED. 

THANK YOU FOR YOUR COOPERATION AND HAVE A SAFE AND HAPPY HOLIDAY SEASON.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2005, THE FOLLOWING CPT CODES WERE ADDED TO THE LIST OF CODES PAYABLE TO CLINICAL NURSE SPECIALIST AND CERTIFIED NURSE PRACTITIONER. 

93017          93018 

CLAIMS WITH DATES OF SERVICE THROUGH JULY 31, 2005, WILL BE PROCESSED UNDER THE "LIST" METHODOLOGY. 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. SEE THE MARCH/APRIL 2005 "LOUISIANA MEDICAID PROVIDER UPDATE" FOR ADDITIONAL INFORMATION. 

PHYSICIAN SUPPLIED/ADMINISTERED INJECTABLE ANTIBIOTICS

EFFECTIVE WITH DATES OF SERVICE DECEMBER 1, 2005 FORWARD, CPT CODE 90788 (IM INJECTION OF ANTIBIOTIC) WILL BE PLACED IN NON-PAY STATUS. FOR INJECTABLE ANTIBIOTICS SUPPLIED AND ADMINISTERED BY THE PHYSICIAN, PHYSICIANS ARE TO USE THE SPECIFIC HCPCS CODE WITH THE APPROPRIATE NUMBER OF UNITS. LOUISIANA MEDICAID'S REIMBURSEMENT FOR THESE HCPCS CODES IS BASED ON AVAILABLE 2005 LOUISIANA MEDICARE AVERAGE SALES PRICE (ASP) AMOUNTS. PROVIDERS ARE REFERRED TO THE PHYSICIAN FEE SCHEDULE ON WWW.LAMEDICAID.COM FOR UPDATED REIMBURSEMENT INFORMATION. 

PHYSICIAN ASSISTANT CLAIM ADJUSTMENTS

PRIOR TO THE IMPLEMENTATION OF THE 80% REIMBURSEMENT METHODOLOGY IN THE CLAIMS PROCESSING SYSTEM, SOME PHYSICIAN ASSISTANT CLAIMS PROCESSED INCORRECTLY, RESULTING IN OVERPAYMENTS. A 'SYSTEM' ADJUSTMENT OF THESE CLAIMS CAN BE FOUND ON THE REMITTANCE OF DECEMBER 6, 2005.

REVISED POLICY: SUBSTITUTE PHYSICIAN BILLING (LOCUM TENENS)

EFFECTIVE DECEMBER 1, 2005, LOUISIANA MEDICAID POLICY REGARDING SUBSTITUTE PHYSICIAN BILLING (RECIPROCAL BILLING AND LOCUM TENENS ARRANGEMENTS) HAS BEEN REVISED. THE REVISED POLICY CAN BE FOUND ON THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM UNDER "NEW MEDICAID INFORMATION/ PROFESSIONAL SERVICES" AND WILL BE PUBLISHED IN THE LOUISIANA MEDICAID PROVIDER UPDATE. PROVIDERS WITHOUT INTERNET ACCESS MAY CALL UNISYS PROVIDER RELATIONS AT 800/473-2783 OR 225/924-5040 TO OBTAIN A COPY OF THE POLICY.