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

ALL PROVIDERS

EFFECTIVE 02/01/07, CLAIMS WITH INVALID ICD-9 DIAGNOSIS AND SURGICAL PROCEDURE CODES WILL DENY FOR ERROR CODE 433. PLEASE SEE THE LAMEDICAID WEBSITE HOME PAGE FOR MORE INFORMATION.

ATTENTION EPSDT PSYCHOLOGICAL AND BEHAVIORAL SERVICES PROVIDERS

EFFECTIVE 12/18/06, RATES FOR SERVICES IN THE EPSDT PSYCHOLOGICAL AND BEHAVIORAL SERVICES PROGRAM HAVE BEEN INCREASED PENDING APPROVAL BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). THE NEW FEE SCHEDULE CAN BE FOUND AT WWW.LAMEDICAID.COM (SEE FEE SCHEDULES LINK). SHOULD YOU HAVE ANY QUESTIONS RELATED TO THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225)924-5040.

ATTENTION DENTAL PROVIDERS - 2007 DENTAL CODING CHANGES

EFFECTIVE FOR DATES OF SERVICE ON OR AFTER 1/1/2007, THE FOLLOWING 3 NEW DENTAL PROCEDURE CODES WILL BE REIMBURSABLE BY MEDICAID IN THE EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT (EPSDT) DENTAL PROGRAM: D0145, D1206 AND D1555. THESE THREE PROCEDURE CODES WILL NOT REQUIRE PRIOR AUTHORIZATION BY MEDICAID. APPLICABLE POLICY FOR EACH PROCEDURE CODE IS PROVIDED ON THE WWW.LAMEDICAID.COM WEBSITE UNDER THE
LINKS ENTITLES "NEW MEDICAID INFORMATION" OR "BILLING INFORMATION." PLEASE NOTE THAT THERE WILL BE A DELAY IN REIMBURSEMENT OF THESE THREE CODES DUE TO PROGRAMMING REQUIREMENTS. ONCE THE REQUIRED PROGRAMMING CHANGES ARE MADE, MEDICAID WILL AUTOMATICALLY RECYCLE DENIED CLAIMS FOR THESE 3 CODES FOR DATES OF SERVICE BETWEEN 1/1/2007 AND THE DATE OF IMPLEMENTATION OF THE PROGRAMMING CHANGES. PLEASE REFER TO THE REVISED EPSDT DENTAL PROGRAM FEE SCHEDULE (REVISION DATE JANUARY 1, 2007) WHICH IS LOCATED AT WWW.LAMEDICAID.COM FOR COMPLETE FEE INFORMATION.

ATTENTION ALL PROVIDERS

LOUISIANA MEDICAID IS IN THE PROCESS OF COMPLETING THE PROGRAMMING FOR THE 2007 HCPCS CODE UPDATES. THIS INCLUDES BOTH NEW AND DELETED CODES FOR 2007. PROVIDERS SHOULD MONITOR FUTURE RA MESSAGES FOR NOTIFICATION OF THE IMPLEMENTATION DATE FOR USE OF NEW 2007 HCPCS CODES.

ATTENTION COMMUNITYCARE PROVIDERS

LOUISIANA MEDICAID WILL BE IMPLEMENTING IMMUNIZATION PAY-FOR-PERFORMANCE SUPPLEMENTAL PAYMENTS TO COMMUNITYCARE PCPS. THESE PAYMENTS WILL BE BASED ON THE PERCENTAGE OF 24 MONTH OLD RECIPIENTS LINKED TO THE PCP THAT ARE UP-TO-DATE WITH ALL RECOMMENDED IMMUNIZATIONS; AND THE PROVIDER'S ENROLLMENT IN AND UTILIZATION OF THE LOUISIANA IMMUNIZATION NETWORK FOR KIDS STATEWIDE (LINKS) IMMUNIZATION REGISTRY AND VACCINES FOR CHILDREN (VFC) PROGRAM. DETAILED INFORMATION REGARDING THE IMMUNIZATION PAY-FOR-PERFORMANCE PAYMENTS CAN BE FOUND AT WWW.LAMEDICAID.COM.

NATIONAL PROVIDER IDENTIFIER

DHH HAS LAUNCHED A NEW NPI WEB REGISTRATION SITE FOR PROVIDERS TO REGISTER THEIR NPI WITH LOUISIANA MEDICAID. CMS WILL REQUIRE ALL HIPAA STANDARD TRANSACTIONS, INCLUDING MEVS ELIGIBILITY INQUIRY AND CLAIMS STATUS INQUIRY TO BE SUBMITTED USING THE NPI NUMBER BEGINNING 23-MAY-07. THE NEW NPI APPLICATION IS ACCESSIBLE FROM THE LIST OF APPLICATIONS IN THE SECURED PROVIDER AREA OF THE WWW.LAMEDICAID.COM WEB SITE. FIND THIS AND MORE ON THE NPI INFORMATION PAGE ACCESSIBLE FROM WWW.LAMEDICAID.COM> HIPAA INFORMATION CENTER> NATIONAL PROVIDER IDENTIFIER (NPI).

ATTENTION PHARMACY PROVIDERS

AS A RESULT OF DELAYED PROCESSING OF 12/15/06 PHARMACY CLAIMS UNTIL THE 1/2/07 RA, WE IDENTIFIED APPROXIMATELY 3000+ OF THESE CLAIMS THAT DID NOT PROCESS CORRECTLY. THESE CLAIMS WERE REPROCESSED AND APPEARED ON THE 1/9/07 RA. THERE IS NOW ONE ADDITIONAL CORRECTION CYCLE TO PROCESS SOME VOID TRANSACTIONS THAT ARE ASSOCIATED WITH CLAIMS RECEIVED ON 12/15/06. THE RESULTS OF THE FINAL CORRECTION SHOULD APPEAR ON THE RA OF 1/16/07. WE REGRET THE INCONVENIENCE CAUSED BY THIS ERROR.