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 FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

PLEASE BE ADVISED THAT THE FOLLOWING NDCS ARE BILLABLE TO MEDICAID BY  THE GRAM AND CANNOT BE BROKEN UP OR PARTIALLY DISPENSED:              

             63032-0021-50 LUXIG 50 - 50 GRAM CANISTER                

             63032-0031-00 OLUX 100 - 100 GRAM CANISTER                

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

CURRENTLY, THE FEE FOR MIRENA CONSISTS OF $302.17 FOR THE IMPLANT AND $35.00 FOR INSERTION.  BECAUSE HIPAA REGULATIONS FORBID THE BUNDLING OF SERVICES, WE ARE CHANGING THE POLICY FOR THE IMPLANTATION OF MIRENA EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2003.

EFFECTIVE THE DATE GIVEN, ONE SHOULD BILL FOR THE IMPLANTATION OF MIRENA BY USING CPT CODE 11981.  BILL FOR THE IMPLANT ITSELF UNDER CODE J7302.  THE FEE FOR J7302 WILL BECOME $384.39 EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2003.  THE FEE FOR CODE 11981 IS $107.06.

HIPAA NOTICE

LA MEDICAID IS USING EDIFECS FOR HIPAA TESTING SERVICES FOR ELECTRONIC SUBMITTERS WHO WOULD LIKE TO BE APROVED TO SEND HIPAA COMPLIANT CLAIMS TO LA MEDICAID FOR PAYMENT.  ASK YOUR SOFTWARE VENDOR, BILLING AGENT, CLEARINGHOUSE, OR SUBMITTER TO EMAIL *HIPAAEDI@UNISYS.COM OR CALL 1-225-237-3318 TO GET ENROLLED IN OUR HIPAA TESTING SERVICE.