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 MAKE THE FOLLOWING CHANGES TO THE 1/01/02 VERSION OF APPENDIX C:

CORRECTIVE MESSAGE- NOTICE TO ALL PROVIDERS

THE PREVIOUSLY PUBLISHED SCHEDULE FOR THE EXPANSION OF THE COMMUNITYCARE
PROGRAM IN 2003 HAS BEEN CHANGED. THE REVISED COMMUNITYCARE IMPLEMENTATION SCHEDULE FOR 2003 IS AS FOLLOWS: 

MARCH 2003 - ACADIA, EVANGELINE, IBERIA, LAFAYETTE, ST. LANDRY, ST. MARTIN, AND VERMILION 
JUNE 2003 - BOSSIER, CADDO, CALDWELL, FRANKLIN, LINCOLN, OUACHITA, AND TENSAS 
SEPTEMBER 2003 - ORLEANS 
DECEMBER 2003 - PLAQUEMINE, ST. BERNARD, JEFFERSON - EAST BANK AND JEFFERSON - WEST BANK 

QUESTIONS REGARDING THIS MATTER MAY BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 1-800-473-2783. 

NOTICE TO ALL PROVIDERS

THIS IS TO INFORM ALL PROVIDERS THAT EFFECTIVE MARCH1, 2003, LOUISIANA MEDICAID WILL EXPAND THE COMMUNITYCARE PROGRAM TO INCLUDE ACADIA, EVANGELINE, IBERIA, LAFAYETTE, ST. LANDRY, ST. MARTIN, AND VERMILION PARISHES. MEDICAID RECIPIENTS IN THESE PARISHES WILL RECEIVE LETTERS AND BROCHURES IN MID-JANUARY TELLING THEM WHEN COMMUNITYCARE IS COMING TO THEIR PARISH AND THAT THEY WILL BE ASSIGNED TO A DOCTOR.DURING THE FIRST WEEK OF FEBRUARY THEY WILL RECEIVE A LETTER TELLING THEM TO WHICH DOCTOR THEY HAVE BEEN ASSIGNED. THE SECOND LETTER WILL ALSO ADVISE RECIPIENTS THAT THEY MAY CHANGE DOCTORS IF THEY DO NOT WANT THE ONE TO WHICH THEY 
HAVE BEEN ASSIGNED, AND WILL PROVIDE THEM WITH A LIST OF COMMUNITYCARE ENROLLED DOCTORS IN THEIR PARISH OF RESIDENCE, AND THE TOLL FREE PHONE NUMBER WHICH THEY CAN CALL TO CHANGE DOCTORS. ALL ENROLLEES WILL HAVE NINETY (90) DAYS TO REQUEST A CHANGE TO A DIFFERENT PROVIDER. ANY MEDICAID PRIMARY CARE PROVIDER (FAMILY PRACTICE, GENERAL PRACTICE, INTERNAL MEDICINE, OB, PEDIATRICIAN) IN THE ABOVE LISTED PARISHES WHO WISHES TO ENROLL AS A COMMUNITYCARE PRIMARY CARE PROVIDER, SHOULD BEGIN THE ENROLLMENT PROCESS NOW. PROVIDERS MUST COMPLETE ENROLLMENT BY JANUARY 15, 2003 IN ORDER TO BE INCLUDED IN THE ASSIGNMENT ROTATION AND AS AN AVAILABLE COMMUNITYCARE PROVIDER ON THE LETTERS WHICH RECIPIENTS WILL RECEIVE IN FEBRUARY. AFTER MARCH 1, 2003, PROVIDERS IN THESE PARISHES WHO DO NOT ENROLL IN COMMUNITYCARE WILL NEED TO OBTAIN A REFERRAL FROM THE COMMUNITYCARE PCP IN ORDER TO BILL FOR SERVICES PROVIDED TO MOST MEDICAID RECIPIENTS. 

NOTICE TO CNPS AND CNSS

EFFECTIVE WITH DATE OF SERVICE JANUARY 01, 2003, THE FOLLOWING CPT CODES
WILL BE ADDED TO THE LIST OF CODES PAYABLE TO CNPS AND CNSS. 

95805 - MSLT, RECORD, ANALYSIS, INTEPRET 
95810 - POLYSOMNOGRAPHY, 4 OR MORE 
95811 - POLYSOMNOGRAPHY W/CPAP 

NOTICE TO REHABILITATION SERVICE PROVIDERS

EFFECTIVE JANAURY 1, 2003, ALL TWENTY MINUTE REHABILITATION SERVICES PROCEDURES WILL BE PUT IN NON-PAY STATUS. PROVIDERS OF THESE SERVICES WILL NEED TO CHOOSE BETWEEN USE OF THE FIFTEEN MINUTE OR THE THIRTY MINUTE PROCEDURE CODE. THE RATES AT WHICH THESE PROCEDURE CODES ARE CURRENTLY REIMBURSED WILL REMAIN THE SAME. 

NOTICE TO PHARMACY AND DME PROVIDERS

EFFECTIVE JANUARY 21, 2003, FOLEY (INDWELLING) CATHETERS AND TRAYS WILL NO LONGER BE REIMBURSABLE UNDER THE PHARMACY PROGRAM. THESE ITEMS WILL BE COVERED UNDER THE DURABLE MEDICAL EQUIPMENT (DME) PROGRAM AND WILL REQUIRE PRIOR AUTHORIZATION BY THE UNISYS PRIOR AUTHORIZATION UNIT (PAU).