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 C:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

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.      

ATTENTION PHARMACY AND PRESCRIBING PROVIDERS

YOU RECENTLY RECEIVED A MEMORANDUM DATED JANUARY 13, 2003 FROM DHH CONCERNING MONTHLY PRESCRIPTION LIMITS & CLINICAL DRUG INQUIRY APPLICATIONS. PAGE 2 OF THAT MEMO CONTAINED ERRORS ON DATES AT THE TOP OF THE PAGE & IN THE BODY OF PARAGRAPH 5. THESE DATES SHOULD READ JANUARY 13, 2003 & FEBRUARY 3, 2003 RESPECTIVELY. PLEASE MAKE CORRECTIONS TO YOUR MEMO, & WE APOLOGIZE FOR ANY CONFUSION THIS ERROR MAY HAVE CAUSED.