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 APPENDIX B:

PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX C:

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 PROFESSIONAL SERVICES PROVIDERS

THE CLAIMS PROCESSING PROGRAMMING THAT PREVENTED PAYMENT OF EVALUATION AND MANAGEMENT CPT CODES (99201-99499) WHEN APPENDED WITH MODIFIER 24 OR MODIFIER 25 HAS BEEN CORRECTED . CLAIMS LESS THAN TWO YEARS OLD THAT INCORRECTLY DENIED HAVE BEEN RECYCLED AND WILL APPEAR ON THE REMITTANCE ADVICES DATED DECEMBER 12, 2006; DECEMBER 19, 2006; OR DECEMBER 26, 2006.

LEVEL OF CARE ELIGIBILITY TOOL (LOCET) IMPLEMENTATION UPDATE

THE DEPARTMENT OF HEALTH AND HOSPITALS (DHH), OFFICE OF AGING AND ADULT SERVICES (OAAS) WILL IMPLEMENT A NEW TOOL TO ASSURE THAT INDIVIDUALS MEET THE MEDICAL NECESSITY REQUIREMENTS FOR ADMISSION TO AND CONTINUED STAY IN ANY LONG TERM CARE PROGRAM WHICH REQUIRES A NURSING FACILITY LEVEL OF CARE. IMPLEMENTATION OF THE LEVEL OF CARE ELIGIBILITY TOOL (LOCET) WILL BE EFFECTIVE 12/1/2006. PROVIDERS ARE ENCOURAGED TO VISIT THE OAAS WEBSITE AT HTTP://WWW.LTSS.DHH.LOUISIANA.GOV (CLICK ON "LOCET IMPLEMENTATION UPDATE") TO OBTAIN MORE INFORMATION ABOUT THIS NEW PROCESS.

EFFECTIVE APRIL 2007
NATIONAL DRUG CODES REQUIRED ON PHYSICIAN ADMINISTERED DRUG CLAIMS

THE DEFICIT REDUCTION ACT OF 2005 (DRA) INCLUDES PROVISIONS REGARDING PHYSICIAN-ADMINISTERED DRUGS AND THE COLLECTION OF MEDICAID DRUG REBATES FROM MANUFACTURERS. CURRENTLY PHYSICIAN-ADMINISTERED DRUGS ARE BILLED TO MEDICAID USING HCPCS CODES. IN ORDER TO SECURE REBATES FROM PHYSICIAN ADMINISTERED DRUGS, THE FEDERAL STATUTE IS REQUIRING THE USE OF NATIONAL DRUG CODES (NDC) FOR DRUG PRODUCTS ADMINISTERED IN THE PHYSICIAN'S OFFICE.

THE NDC NUMBER AND HCPCS CODE FOR DRUG PRODUCTS WILL BE REQUIRED ON BOTH THE 837P (ELECTRONIC FORM) AND THE CMS-1500 (PAPER FORM). THIS REQUIREMENT WILL BEGIN WITH IMPLEMENTATION OF THE NEW CMS-1500 FORM.  PROVIDERS MUST UPDATE THEIR BILLING SOFTWARE TO ENSURE THAT THESE FEDERAL REQUIREMENTS ARE MET. PROVIDERS SHOULD MONITOR WWW.LAMEDICAID.COM FOR SPECIFIC POLICY AND BILLING INSTRUCTIONS.

ATTENTION PROVIDERS

EFFECTIVE FEBRUARY 1, 2007, CLAIMS WITH INVALID ICD-9 DIAGNOSIS AND SURGICAL PROCEDURE CODES WILL DENY WITH ERROR CODE 433. PLEASE SEE THE LAMEDICAID WEBSITE HOME PAGE FOR MORE INFORMATION.

ATTENTION 1500 AND UB PROVIDERS

THE OFFICE OF MANAGEMENT AND BUDGET (OMB), THE NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) AND THE NATIONAL UNIFORM BILLING COMMITTEE (NUBC) HAVE GIVEN THEIR STAMP OF APPROVAL TO THE NEW 1500 HEALTH INSURANCE CLAIM FORM (VERSION 08/05) AND THE NEW UB-04 CLAIM FORM. THE LOGISTICS FOR DISTRIBUTION AND TRANSITION TO THESE REVISED FORMS, INCLUDING EFFECTIVE DATES FOR USE BY PROVIDERS AND ACCEPTANCE BY PAYERS, IS UNDER REVIEW BY THE COMMITTEES. IT IS VERY IMPORTANT THAT YOU DO NOT BEGIN USING THESE NEW FORMS FOR LA MEDICAID BILLING UNTIL YOU ARE INFORMED OF THE EFFECTIVE DATE OF THE TRANSITION FOR LA MEDICAID CLAIMS PROCESSING. YOU WILL BE KEPT INFORMED OF ALL NECESSARY INFORMATION FOR IMPLEMENTING THESE FORMS FOR LA MEDICAID BILLING THROUGH RA MESSAGES, NEWSLETTER ARTICLES, AND PROVIDER NOTICES POSTED ON OUR WEB SITE WWW.LAMEDICAID.COM . PLEASE WATCH THESE INFORMATION AVENUES FOR THE MOST UP-TO-DATE INFORMATION FOR BILLING LA MEDICAID.