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 A:

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

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

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

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 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). 

NOTICE TO ALL EPSDT DENTAL PROVIDERS

THE RECYCLE PROCESS REGARDING THE JULY 6, 2002 DENTAL RATE INCREASE WAS FINALIZED AND APPEARED IN THE DECEMBER 10, 2002 REMITTANCE ADVICE. IN THIS PROCESS, CLAIMS WHICH WERE NOT DUE AN ADDITIONAL PAYMENT (I.E., INSTANCES WHERE THE PROVIDER BILLED LESS THAN THE NEW RATE) WERE CAPTURED AND INADVERTENTLY APPEARED ON THE REMITTANCE ADVICE OF DECEMBER 10, 2002. THIS PROCESS GENERATED NEW INTERNAL CONTROL NUMBERS (ICN) FOR ALL PREVIOUSLY PROCESSED CLAIM LINES WHICH CONTAINED ANY PROCEDURE CODE THAT RECEIVED A RATE INCREASE. IF IT IS NECESSARY FOR PROVIDERS TO SUBMIT AN ADJUSTMENT BECAUSE THEIR BILLED CHARGES WERE LESS THAN THE INCREASED RATE, THE NEW ICN CONTAINED ON THE DECEMBER 10, 2002 REMITTANCE ADVICE MUST BE USED WHEN FILING THE ADJUSTMENT. ANY ADJUSTMENTS PROCESSED BY 
JANUARY 21, 2003 WITH THE ORIGINAL CLAIM ICN WILL DENY WITH AN EOB DENIAL CODE OF 798 - HISTORY RECORD ALREADY ADJUSTED; HOWEVER, WE WILL AUTOMATICALLY REPROCESS THESE ADJUSTMENTS WHICH DENIED WITH EOB 798 AGAINST THE ORIGINAL CLAIM ICN FOR A PERIOD OF SIX WEEKS IN ORDER TO MINIMIZE THE PAPERWORK FOR THE PROVIDER. THE PROVIDER WILL BE RESPONSIBLE FOR RESUBMITTING ANY ADJUSTMENT WHICH DENIES AFTER THE CHECK WRITE DATE OF JANUARY 21, 2003. 

ANY FUTURE ADJUSTMENTS, WHICH ARE NECESSARY BECAUSE OF THE JULY 6, 2002 DENTAL RATE INCREASES AND HAVE NOT ALREADY BEEN COMPLETED BY THE PROVIDER, MUST CONTAIN THE ICN NUMBER LOCATED ON THE DECEMBER 10, 2002 REMITTANCE ADVICE. WE APOLOGIZE FOR ANY INCONVENIENCE. SHOULD YOU HAVE ANY QUESTIONS, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING 1-800-473-2783 OR 225-924-5040; THE MEDICAID DENTAL CONSULTANTS AT THE LSUHSC DENTAL MEDICAID UNIT BY CALLING 504-619-8589 OR TERRI NORWOOD, MEDICAID DENTAL PROGRAM SPECIALIST, BY CALLING 225-342-9403.