RA Messages for January 22, 2002

 PHARMACY PROVIDERS, PLEASE NOTE!!!

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

LABELER    COMPANY   BEGIN  END
38206 NUTRAMAX     01/01/02 
57480   MEDIREX, INC    01/01/02
58865 DAWN WHOLESALE PHARMA.,INC    01/01/02 
59243  SAGE PHARMACEUTICALS INC   01/01/02    

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

DRUG DOSAGE  STRGTH MAC EFF DATE
AMITRIPTYLINE TABLET   25MG 0.05480 01/22/02
ATENOLOL TABLET 25MG  0.06140  01/22/02  
CHLORTHALIDONE    TABLET 50MG 0.05580 01/22/02  
DEXAMETHASONE ELIXIR  0.5MG/5ML 0.03960 01/22/02
DILTIAZEM HCL  CAP.SR 24HR 240MG  OFF MAC  01/22/02
HYDROCOD BIT/HOMATROPINE SYRUP 5-1-.5MG/5 0.02800   01/22/02  
HYDROXYZINE HCL TABLET  10MG  0.05250 01/22/02 
 IS0SORBIDE DINITRATE TAB SUBL  5MG  0.04630 09/30/97
LOPERAMIDE HCL    CAPSULE  2MG 0.59300  09/30/97  
NADOLOL  TABLET 20MG  0.46500 01/22/02
NAPROXEN SODIUM TABLET  275MG  0.14890 01/22/02 
NORTRIPTYLINE HCL CAPSULE  75MG 0.22030 01/22/02 
NITROGLYCERIN  PATCH TD 24 0.2MG/HR  1.39883  09/30/97 
NITROGLYCERIN  PATCH TD 24 0.4MG/HR 1.60000  08/31/98  
NITROGLYCERIN  PATCH TD 24 0.6MG/HR OFF MAC  10/31/99 
NYSTATIN  ORAL SUSP 100MU/ML 0.00850 01/22/02  
OXAZEPAM  CAPSULE 10MG 0.53630 01/22/02
OXAZEPAM  CAPSULE 15MG 0.76240  01/22/02
PERPHENAZINE   TABLET 8MG  O.73600 09/30/97
PRAZOSIN HCL CAPSULE  1MG  0.24150  09/30/97 
PRAZOSIN HCL CAPSULE  5MG 0.57600 09/30/97 
PROPRANOLOL HCL  TABLET 20MG  0.07500 01/22/02  
PROPRANOLOL HCL  TABLET 40MG  0.05900  01/22/02  
THEOPHYLLINE ANHYDROUS  TAB/SR12H 100MG  0.09570  01/22/02 
TRIAMCINOLONE ACETONIDE CREAM 0.1%   0.04480 01/22/02  

 IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT  THE PBM HELP DESK AT 1-800-648-0790.

PHARMACY AND PRESCRIBING PROVIDERS

THE LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS ANNOUNCES THAT IT HAS ENTERED INTO A PROVIDER ENROLLMENT AGREEMENT ADDENDUM WITH A PHARMACY PROVIDER.  THE PROVIDER HAS INITIATED A PROGRAM DESIGNED TO REDUCE MEDICAID PROGRAM EXPENDITURES FOR THE PROVISION OF DIABETIC AND ASTHMA PRESCRIPTION DRUGS, SELF-MANAGEMENT PRODUCTS AND EDUCATION AND SUPPORT SERVICES TO MEDICAID RECIPIENTS WITH A DIAGNOSIS OF DIABETES OR ASTHMA. IT HAS BEEN INDICATED THAT THE DEPARTMENT COULD REALIZE SAVINGS OF UP TO $10 MILLION ON AN ANNUAL BASIS THROUGH THE IMPLEMENTATION IF THE PROVIDER'S PROGRAM.  RECIPIENT PARTICIPATION IN THIS PROGRAM IS VOLUNTARY. INFORMATION REGARDING THIS PROGRAM IS AVAILABLE IN THE DHH WEBSITE AT HTTP://WWW.DHH.STATE.LA.US/MEDICAID/PUBLICATIONS.HTM  IF YOU ARE INTERESTED IN MAKING AN ADDENDUM TO YOUR PROVIDER ENROLLMENT AGREEMENT WITH THE DEPARTMENT TO REDUCE MEDICAID EXPENDITURES FOR THE PRESCRIPTION DRUGS AND SERVICES THAT YOU PROVIDE TO MEDICAID RECIPIENTS, YOU MAY CONTACT UNISYS PROVIDER RELATIONS AT 1-800-473-2783.

VISION SERVICES AND EYE CARE PROGRAM PROVIDERS
CLARIFICATION OF SAME DAY/SUBSEQUENT DAY FOLLOW-UP OFFICE VISIT POLICY

A SEPARATE SAME DAY OR SUBSEQUENT DAY FOLLOW-UP OFFICE VISIT IS ALLOWED FOR THE PURPOSE OF THE DELIVERY, AND FINAL ADJUSTMENT TO THE VISUAL AXES AND ANATOMICAL TOPOGRAPHY OF MEDICAID-COVERED EYEGLASSES, CATARACT GLASSES, OR CONTACT LENSES. PRESENCE OF THE PHYSICIAN IS NOT REQUIRED. IF THE VISIT MEETS THESE CRITERIA, THE PROVIDER SHOULD BILL PROCEDURE CODE 99211. DOCUMENTATION IN THE PATIENT'S RECORD SHOULD REFLECT THAT THE PATIENT RETURNED FOR A SEPARATE VISIT ON THE SAME DAY OR SUBSEQUENT DAY FOR THE PURPOSE OF THE DELIVERY, AND FINAL ADJUSTMENT OF THE EYE WEAR, AND MUST INCLUDE A DESCRIPTION OF THE SERVICES PROVIDED. IF THE PATIENT RETURNS ON THE SAME DAY OR SUBSEQUENT DAY SIMPLY TO PICK UP THEIR EYE WEAR, AND NO FINAL ADJUSTMENTS TO THE VISUAL AXES, AND ANATOMICAL TOPOGRAPHY ARE PERFORMED, THE PROVIDER MUST NOT BILL FOR THIS SERVICE. SHOULD YOU HAVE ANY FURTHER QUESTIONS REGARDING THIS POLICY, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING 1-800-473-2783.

ATTENTION PHARMACY PROVIDERS

FOR A SHORT PERIOD THIS PAST WEEKEND, PHARMACY PROVIDERS WERE RECEIVING AN INAPPROPRIATE DISPENSING FEE DUE TO A CORRUPTION ISSUE IN THE SYSTEM.  THE CORRUPTION HAS BEEN IDENTIFIED AND CORRECTED. ADJUSTMENTS WERE INITIATED TO ADJUST ONLY THOSE CLAIMS WHICH CONTAINED THE ERRONEOUS DISPENSING FEE AND EXCLUDED CLAIMS WHICH HAS ALREADY BEEN ADJUSTED BY PROVIDERS. YOUR RA WILL INDICATE THE ORIGINAL PAYMENT, REVERSAL OF THAT PAYMENT, AND THE NEW, CORRECT PAYMENT. WE APOLOGIZE FOR ANY CONFUSION RESULTING FROM THIS AND THANK YOU FOR YOUR UNDERSTANDING IN THIS MATTER.