RA Messages for December 16, 2008

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.  

PLEASE NOTE THE FOLLOWING CHANGES TO APPENDIX A

         DRUG                                         DOSE             STRGTH             FUL             LMAC                 EFF
CLORAZEPATE DIPOTASS             TABLET            7.5MG          $0.19470                                  11/28/08
CLOTRIMAZOLE                              CREAM                1%                                    $1.08733           11/17/08
DESOXIMETASONE                        CREAM              0.25%                                  $2.15900          10/30/08
HYDROCODONE BIT/ACET           TABLET            7.5/650MG                           $0.69500           11/28/08
MORPHINE SULFATE                   SOLUTION        20MG/ML                             OFF MAC         12/02/08

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. 

The 2008 Holiday EDI Processing Schedule will be as follows

Tuesday 11/25/08 4:30PM - KIDMED deadline
Wednesday 11/26/08 10:00AM deadline - all claims (with exception of KIDMED and LTC)

Wednesday 12/24/08 10:00AM deadline - all claims (with exception of LTC)
Wednesday 12/31/08 10:00AM deadline - all claims (with exception of LTC)

PEDIATRIC CRITICAL CARE PATIENT TRANSPORT

Effective with date of service January 1, 2008 forward, Louisiana Medicaid reimburses CPT codes 99289 and 99290 (Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less;...). Policy regarding these services can be found on the Medicaid website homepage, www.lamedicaid.com, and via the link there to "New Medicaid Information".

ATTENTION PROVIDERS OF IMMUNIZATIONS

Effective with date of service August 6, 2008, reimbursement rates for select immunization administration codes (90465, 90467, 90471, and 90473) have been updated utilizing the same reimbursement methodology as used for the Professional Services 2008 reimbursement rate changes. However, the updated immunization administration rates cannot exceed the maximum regional charge, currently $15.22, as determined by CMS. This rate is used where applicable. The updated rates can be found on the Immunization Fee Schedules located on the Medicaid website, www.lamedicaid.com, following the Fee Schedules link. Affected claims paid at the previous rate will be systematically adjusted in the near future and no action will be required by providers. Please monitor your RA's for the specific date(s) the adjustments will take place.

ALL PROVIDERS WITH PART A CROSSOVER CLAIMS

We have recently become aware that not all of the Medicare Part A Crossover claims were processed for the month of November. These claims have been identified and will be processed in the RA's of 12/16/08 and/or 12/23/08. If you believe you have outstanding Part A claims after the aforementioned RA's have been received, you will need to submit them hardcopy with Medicare EOMB attached.