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 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 MENTAL HEALTH REHABILITATION PROVIDERS

EFFECTIVE 01/02/06, ALL MHR PSYCHIATRISTS WILL BE REQUIRED TO USE THE MEDICAID ELECTRONIC CLINICAL DRUG INQUIRY (E-CDI) APPLICATION. THE E-CDI APPLICATION, WHICH IS UPDATED NIGHTLY, ALLOWS THE PSYCHIATRISTS TO REVIEW THE RECIPIENT'S MEDICAID PAID DRUG CLAIMS FROM THE PREVIOUS FOUR MONTHS. THE MHR PROVIDER IS RESPONSIBLE FOR SUBMITTING A COPY OF THE RECIPIENT'S CLINICAL DRUG INQUIRY PAGE WITH EACH PRIOR AUTHORIZATION REQUEST SUBMITTED. THE MHR ENROLLED PSYCHIATRIST MUST SIGN A PRINTED COPY OF THE E-CDI SCREEN, INDICATING A REVIEW OF THE RECIPIENT'S PRESCRIPTION UTILIZATION WAS COMPLETED. IF THE MHR PROVIDER FAILS TO SUBMIT THIS INFORMATION WITH THE PRIOR AUTHORIZATION REQUEST, THE REQUEST WILL BE DENIED. IN ORDER TO GAIN ACCESS INTO THE MEDICAID E-CDI APPLICATION, THE PSYCHIATRIST MUST ESTABLISH AN ONLINE ACCOUNT WITH LAMEDICAID.COM. THE FOLLOWING IS NEEDED TO ESTABLISH AN ONLINE ACCOUNT: A VALID 7- DIGIT PROVIDER ID # ASSIGNED BY LOUISIANA MEDICAID, AN INTERNET ACCT. WITH AN INTERNET SERVICE PROVIDER, VALID EMAIL ADDRESS, AND A WEB BROWSER THAT SUPPORTS SSL WITH 128-BIT ENCRYPTION (EXAMPLE: MICROSOFT INTERNET EXPLORER V5 OR V6).

ATTENTION PROVIDERS

LA MEDICAID RECENTLY INFORMED PROVIDERS THAT THE 2006 ICD-9-CM DISEASE AND PROCEDURE CLASSIFICATION UPDATE WAS COMPLETE AND THAT VALID CODES MUST BE USED ON CLAIM SUBMISSIONS WITH DOS 10-1-05 FORWARD. DELETED OR INVALID CODES WERE PLACED IN NON-PAY STATUS, RESULTING IN DENIAL ERROR 433. TO ALLOW PROVIDERS TO MAKE NECESSARY CHANGES IN THEIR CLAIM SYSTEMS, EFFECTIVE IMMEDIATELY UNTIL MARCH 1, 2006, ERROR 433 WILL BE 'EDUCATIONAL ONLY' FOR CLAIMS WITH INVALID CODES. FOLLOWING THE GRACE PERIOD AND PROVIDER NOTIFICATION, CLAIM WILL AGAIN DENY WITH ERROR 433. FOR INFORMATION REGARDING ICD-9-CM OFFICIAL GUIDELINES FOR CODING AND REPORTING, PROVIDERS MAY ACCESS THE CMS WEBSITE AT HTTP://WWW.CMS.HHS.GOV/ICD9PROVIDERDIAGNOSTICCODES/ 

GUIDELINES FOR PROVIDERS TO RESOLVE BILLING ISSUES

TO EFFECTIVELY ASSIST PROVIDERS WITH BILLING AND CLAIM PROCESSING ISSUES, IT IS NECESSARY FOR ALL PROVIDERS TO FOLLOW THE PROCEDURES IN PLACE FOR HANDLING THESE PROBLEMS, AS SHOWN BELOW: 

1. PROVIDERS ARE TO DIRECT ALL BILLING AND CLAIM PROCESSING QUESTIONS TO
THE UNISYS PROVIDER RELATIONS INQUIRY UNIT AT (800)473-2783 OR (225) 924-5040. 

2. IF INQUIRY UNIT PERSONNEL ARE UNABLE TO RESOLVE THE ISSUE, THE INQUIRY UNIT STAFF WILL FORWARD A REQUEST FOR PROVIDER CONTACT TO THE APPROPRIATE UNISYS REGIONAL FIELD ANALYST. THE FIELD ANALYST WILL CONTACT THE PROVIDER TO DISCUSS THE ISSUE AND RESOLVE IT VIA TELEPHONE OR SCHEDULE A FIELD VISIT TO PURSUE ADDITIONAL INFORMATION TO REACH A SATISFACTORY CONCLUSION. 

3. IF THE FIELD ANALYST IS UNABLE TO RESOLVE A PROVIDER'S BILLING ISSUES, THE FIELD ANALYST WILL FORWARD THE ISSUE TO THE DHH STATE OFFICE FOR CONSULTATION. THE DHH STATE OFFICE WILL RESPOND TO THE FIELD ANALYST WHO WILL IN TURN NOTIFY THE PROVIDER.

GUIDELINES FOR PROVIDERS TO SUBMIT CLAIMS 
FOR A TWO-YEAR OVERRIDE CONSIDERATION 

PROVIDERS REQUESTING TWO-YEAR OVERRIDES FOR CLAIMS WITH DATES OF SERVICE OVER TWO YEARS OLD MUST PROVIDE PROOF OF TIMELY FILING AND MUST ASSURE  THAT EACH CLAIM MEETS AT LEAST ONE OF THE THREE CRITERIA LISTED BELOW: 

1) THE RECIPIENT WAS CERTIFIED FOR RETROACTIVE MEDICAID BENEFITS, AND THE CLAIM WAS FILED WITHIN 12 MONTHS OF THE DATE RETROACTIVE ELIGIBILITY WAS GRANTED. 

2) THE RECIPIENT WON A MEDICARE OR SSI APPEAL IN WHICH HE OR SHE WAS GRANTED RETROACTIVE MEDICAID BENEFITS. 

3) THE FAILURE OF THE CLAIM TO PAY WAS THE FAULT OF THE LOUISIANA MEDICAID PROGRAM RATHER THAN THE PROVIDER'S FAULT EACH TIME THE CLAIM WAS ADJUDICATED. 

ALL PROVIDER REQUESTS FOR TWO-YEAR OVERRIDES MUST BE MAILED DIRECTLY TO THE UNISYS PROVIDER RELATIONS CORRESPONDENCE UNIT, P.O. BOX 91024, BATON ROUGE, LA 70821. THE PROVIDER MUST SUBMIT THE CLAIM WITH A COVER LETTER DESCRIBING THE CRITERIA THAT HAS BEEN MET FOR CONSIDERATION ALONG WITH ALL SUPPORTING DOCUMENTATION. SUPPORTING DOCUMENTATION INCLUDES BUT IS NOT LIMITED TO PROOF OF TIMELY FILING AND EVIDENCE OF THE CRITERIA MET FOR CONSIDERATION. 

CLAIMS SUBMITTED WITHOUT A COVER LETTER, PROOF OF TIMELY FILING, AND/OR 
SUPPORTING DOCUMENTATION WILL BE RETURNED TO THE PROVIDER WITHOUT 
CONSIDERATION. ANY REQUESTS SUBMITTED DIRECTLY TO DHH STAFF WILL BE 
ROUTED TO UNISYS PROVIDER RELATIONS. 

ATTENTION PROFESSIONAL SERVICES PROVIDERS

LOUISIANA MEDICAID IS IN THE PROCESS OF COMPLETING THE PROGRAMMING FOR THE 2006 HCPCS CODE UPDATES WHICH INCLUDE NEW AND DELETED CODES. PLEASE MONITOR FUTURE RA MESSAGES FOR NOTIFICATION OF THE IMPLEMENTATION DATE FOR USE OF THE 2006 HCPCS CODES BY LOUISIANA MEDICAID.