RA Messages for December 15, 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.
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.
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.
ATTENTION
PROVIDERS OF CHILDHOOD IMMUNIZATIONS
A new
vaccine for the booster dose of children aged 15 months through 4 years
for the Haemophilus influenzae type b (Hib) immunization series is
available from the Vaccines for Children (VFC) Program. The American
Medical Association (AMA) has released guidelines for the use of the
Current Procedural Terminology (CPT) procedure code 90648 for reporting
the use of this Hib booster vaccine for the booster (final) dose of the
Hib immunization series (see CPT Assistant September 2009). Louisiana
Medicaid follows this guidance from the AMA and providers of childhood
vaccines should use CPT code 90648 for reporting this vaccine. If
nationally approved changes occur to CPT codes at a future date,
providers are to follow the most accurate coding available for covered
services, unless otherwise directed.
Louisiana
Medicaid will reimburse providers for the administration only of the
vaccine as the vaccine is available from the Louisiana VFC program at no
charge to VFC enrolled providers. Providers should contact the Unisys
Provider Relations unit at (800) 473-2783 or (225) 924-5040 with billing
policy questions. Questions related to this vaccine including its
availability should be directed to the Louisiana Office of Public
Health-Immunization Program at (504) 838-5300.
NURSING HOME
PROVIDERS
2010
Case-Mix Rate Workshop
January 25, 2010
1:00 p.m.- 4:30 p.m.
DEQ Oliver Pollock
C111 Conference Room
602 N. Fifth Street
Baton Rouge, LA 70802
This program has been designed to provide nursing facility personnel and
consultants an understanding of the Louisiana case-mix rate methodology,
case-mix calculations, fair rental value bed-buy back, private room
conversions, and the use of cost report data.
The
training is appropriate for Cost Report Preparers, Accountants
(including Home Office Staff), CFO's, Controllers, Office Managers, and
Others involved in Case-Mix Rate Reviews.
4 CPE credits: Specialized Knowledge & Applications
Submit registration by January 18, 2010
To download the registration form, go to http://www.dhh.la.gov/offices/events.asp?ID=111&detail=7910
or contact Myers & Stauffer LC @ 1-800-374-6858
ATTENTION
MULTI-SYSTEMIC THERAPY (MST) PROVIDERS
Providers
may now view the current MST Provider Manual on the Medicaid website,
www.lamedicaid.com.