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.

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.

IMPORTANT COMMUNITYCARE AND KIDMED INFORMATION

THE COMMUNITYCARE REFERRAL AND KIDMED LINKAGE AND TIMELY FILING REQUIREMENTS WERE TEMPORARILY WAIVED FOR ENROLLEES FROM THE PARISHES MOST DIRECTLY AFFECTED BY HURRICANES KATRINA AND RITA. FOR ENROLLEES FROM THE FOLLOWING PARISHES: VERMILION, CALCASIEU, ST. TAMMANY, WEST JEFFERSON, IBERIA, AND ST. MARY, THOSE WAIVERS WILL END EFFECTIVE FOR DATES OF SERVICE BEGINNING 1-1-2006. THIS MEANS THAT IF YOU PROVIDE MEDICAL CARE ON OR AFTER 1-1-2006, TO A COMMUNITYCARE ENROLLEE FROM ONE OF THE ABOVE PARISHES, AND YOU ARE NOT THE PCP OF RECORD, YOU WILL NEED A REFERRAL FROM THE PCP IN ORDER TO BE PAID BY MEDICAID. SERVICES PROVIDED TO KIDMED ENROLLEES WHO ARE NOT IN COMMUNITYCARE MUST BE PROVIDED BY THE KIDMED PROVIDER OF RECORD AND FILED WITH MEDICAID IN ACCORDANCE WITH KIDMED TIMELY FILING REQUIREMENTS. THE COMMUNITYCARE REFERRAL/KIDMED LINKAGE AND TIMELY FILING REQUIREMENTS WILL CONTINUE TO BE WAIVED FOR RECIPIENTS FROM ORLEANS, ST. BERNARD, PLAQUEMINES, EAST JEFFERSON AND CAMERON PARISHES UNTIL FURTHER NOTICE. 

ATTENTION PHARMACY PROVIDERS

THE PHARMACY BENEFITS MANAGEMENT SERVICE MANUAL IS NOW AVAILABLE AT WWW.LAMEDICAID.COM. THIS MANUAL HAS BEEN DESIGNED TO PROVIDE THE PHARMACY PROVIDER WITH THE LATEST MEDICAID POLICY IN A CONCISE AND EASY TO READ FORMAT. THE MANUAL WILL BE UPDATED AS CHANGES IN POLICY OCCUR. 

EFFECTIVE 1-1-2006, FULL BENEFIT DUAL ELIGIBLE MEDICAID RECIPIENTS WILL NO LONGER RECEIVE THEIR PHARMACY BENEFITS THROUGH THE LOUISIANA MEDICAID PHARMACY PROGRAM WITH THE EXCEPTION OF SOME DRUGS EXCLUDED FROM THE PART D BENEFIT. A DETAILED LETTER REGARDING MEDICARE PART D AS IT RELATES TO FULL BENEFIT DUAL ELIGIBLE MEDICAID RECIPIENTS IS POSTED ON THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM.