RA Messages for January 25, 2005

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 APPENDIX A:  

DRUG DOSAGE STRGTH MAC EFF DATE
AMINOPHYLLINE TABLET  100MG $0.05990 02/14/05
AMINOPHYLLINE TABLET  200MG $0.06050 02/14/05
ATENOLOL TABLET 25MG $0.09750 02/14/05
BENAZEPRIL HCL TABLET 5MG $0.49050 02/14/05
BENAZEPRIL HCL TABLET 10MG $0.49050  02/14/05
BENAZEPRIL HCL TABLET 20MG $0.49050 02/14/05
BENAZEPRIL HCL TABLET 40MG  $0.49050 02/14/05
BENAZEPRIL/HCTZ TABLET 5-6.25MG $0.49580 02/14/05
BENAZEPRIL/HCTZ TABLET 10-12.5MG $0.49580 02/14/05
BENAZEPRIL/HCTZ TABLET 20-12.5MG $0.49580 02/14/05
BENAZEPRIL/HCTZ TABLET 20-25MG $0.49580 02/14/05
CEPHALEXIN MONOHYDRATE CAPSULE 250MG $0.18350 02/14/05
CEPHALEXIN MONOHYDRATE CAPSULE 500MG $0.36410 02/14/05
CIPROFLOXACIN HCL DROPS 0.3% $7.56900 02/14/05
CIPROFLOXACIN HCL TABLET 250MG $0.37500  02/14/05
CIPROFLOXACIN HCL TABLET 500MG $0.45000 02/14/05
CIPROFLOXACIN HCL TABLET 750MG $0.48000 02/14/05
HYDRALAZINE HCL TABLET 10MG $0.03600 02/14/05
IPRATROPIUM BROMIDE SOLUTION 0.2MG/ML $0.10800 02/14/05
KETOCONAZOLE TABLET 200MG $2.25000 02/14/05
METOPROLOL TARTRATE TABLET 50MG $0.05000 02/14/05
OXYCODONE HCL  CAPSULE 5MG $0.21380 02/14/05
OXYCODONE HCL  ORAL CONC 20MG/ML $0.95000 02/14/05
OXYCODONE HCL  TABLET 5MG $0.23990 02/14/05
OXYCODONE HCL  TABLET 15MG $0.66950 02/14/05
OXYCODONE HCL  TABLET 30MG $1.30940 02/14/05
PAROXETINE HCL TABLET 10MG $2.43000 02/14/05
PAROXETINE HCL TABLET 20MG $2.52000 02/14/05
PAROXETINE HCL TABLET 30MG $2.61000 02/14/05
PAROXETINE HCL TABLET 40MG $2.70000 02/14/05
PERGOLIDE MESYLATE TABLET 1MG OFF MAC 02/14/05

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

ATTENTION PHARMACY PROVIDERS

RECENTLY STATES WERE NOTIFIED BY THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) TO MAKE CERTAIN DRUG PRODUCTS NON-PAYABLE BECAUSE THEY WERE NOT PROPERLY LISTED WITH THE FOOD AND DRUG ADMINISTRATION EFFECTIVE JANUARY 1, 2005. LA MEDICAID WILL REINSTATE THESE PRODUCTS AS PAYABLE IF NOTIFIED BY CMS TO DO SO.

ATTENTION PROVIDERS SUBMITTING ELECTRONIC CLAIMS

IT IS IMPERATIVE THAT ALL EMC PROPRIETARY ELECTRONIC CLAIMS SUBMISSIONS CONVERT TO HIPAA COMPLIANT FORMS AS QUICKLY AS POSSIBLE. PLEASE CONTACT YOUR VENDOR, BILLING AGENT, OR CLEARINGHOUSE TO ENSURE THAT THEY ARE COMPLETING ALL NECESSARY TESTING TO ALLOW UNINTERRUPTED SUBMISSION OF ELECTRONIC CLAIMS. SPECIFIC DEADLINES FOR EDI TRANSACTIONS ARE AS FOLLOWS: 

PROFESSIONAL AND KIDMED - MARCH 31, 2005 
OTHER PROGRAMS - TO BE DETERMINED 

PROPRIETARY CLAIMS SUBMITTED AFTER APPLICABLE DEADLINES WILL NOT BE PROCESSED. 

ATTENTION ALL PROVIDERS CURRENTLY TESTING 837 EDI TRANSACTIONS AND RECEIVING TEST 835S: THE TEST EDI BULLETIN BOARD WILL BE UNAVAILABLE FROM MIDNIGHT JANUARY 27TH, 2005 THROUGH 10:00 A.M., JANUARY 31, 2005 DUE TO ROUTINE MAINTENANCE. PLEASE SCHEDULE YOUR 837 TESTING AROUND THIS SCHEDULED DOWNTIME.

ATTENTION PROFESSIONAL SERVICES PROVIDERS

THE MESSAGE THAT RAN ON THE RAS DATED 09/23/03, 09/30/03, AND 10/07/03, 
CONCERNING A FEE INCREASE FOR PROCEDURE CODES RELATED TO MUSCULOSKELETAL SYSTEM SERVICES, CONTAINED AN INCORRECT CODE RANGE. THE CORRECT CODE RANGE FOR THIS FEE IS 20000-29999. PLEASE MAKE THIS NECESSARY CORRECTION TO YOUR INTERNAL DOCUMENTATION. 

ATTENTION ALL PROVIDERS

EFFECTIVE APRIL 1, 2005, ALL HARDCOPY AND PROPRIETARY ELECTRONIC MEDIA CLAIMS ELIGIBLE FOR 837 HIPAA COMPLIANT TRANSACTIONS SUBMISSION WILL BE HELD AT LEAST 21 DAYS PRIOR TO FINAL ADJUDICATION. ALL CLAIMS RECEIVED FOR LONG TERM CARE, CASE MANAGEMENT, AND NON-EMERGENCY TRANSPORTATION SERVICES AND CLAIMS REQUIRING ATTACHMENTS WILL NOT BE DELAYED BY THIS PROCESS. IT IS IMPERATIVE THAT YOU BEGIN SUBMITTING ELECTRONIC CLAIMS IN APPROVED 837 TRANSACTIONS PRIOR TO THIS IMPLEMENTATION TO ENSURE THAT PAYMENTS WILL NOT BE DELAYED. FOR ANY QUESTIONS, PLEASE CALL PROVIDER RELATIONS AT 800-473-2783 OR (225)924-5040.