RA Messages for January 29, 2002

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 PHARMACY PROVIDERS, PLEASE NOTE!!!

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

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

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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.

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ATTENTION ALL MEDICAID PROVIDERS

ALL PROVIDERS ARE RESPONSIBLE FOR ENSURING THAT YOUR PROFESSIONAL EMPLOYEES (EX. RNS, LPNS, CNPS, ETC.) ARE ONLY PRACTICING WITHIN THE LIMITATIONS ESTABLISHED BY THEIR LICENSING BOARDS. 

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ATTENTION ALL MEDICAID PROVIDERS

IT HAS COME TO THE DEPARTMENT'S ATTENTION THAT SOME PROVIDERS ARE SENDING IDENTIFYING INFORMATION OVER THE INTERNET THAT MAY OR MAY NOT BE ENCRYPTED. DO NOT SEND ANY IDENTIFYING INFORMATION (EG. NAME, SOCIAL SECURITY NUMBERS, MEDICAID NUMBERS, ETC.) OVER THE INTERNET UNLESS THE INFORMATION IS ENCRYPTED. 

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ATTENTION DENTAL PROVIDERS

INFORMATION REGARDING ENROLLMENT AS A MEDICAID DENTAL PROVIDER

EACH INDIVIDUAL DENTIST MUST BE ENROLLED IN THE LOUISIANA MEDICAID PROGRAM IN ORDER TO RECEIVE REIMBURSEMENT FROM THE MEDICAID PROGRAM FOR DENTAL SERVICES PERFORMED ON MEDICAID RECIPIENTS.IN ORDER FOR A DENTAL GROUP, CLINIC, ETC.,TO RECEIVE PAYMENT FROM MEDICAID FOR SERVICES RENDERED TO A MEDICAID RECIPIENT, THE GROUP MUST BE ENROLLED IN THE MEDICAID PROGRAM AND HAVE THE INDIVIDUAL ATTENDING DENTIST LINKED TO THAT GROUP. THIS REQUIRED THAT THE INDIVIDUAL ATTENDING DENTIST MUST ALSO BE ENROLLED IN THE MEDICAID PROGRAM.IF AN INDIVIDUAL DENTIST IS NOT ENROLLED AS A MEDICAID DENTAL PROVIDER, HE/SHE MAY NOT USE THE NAME AND PROVIDER NUMBER OF ANOTHER DENTIST IN ORDER TO RECEIVE REIMBURSEMENT FROM MEDICAID. 
A CLAIM FOR DENTAL SERVICES SHOULD NOT BE SUBMITTED TO MEDICAID FOR PAYMENT RENDERED BY A DENTIST WHO IS NOT ENROLLED IN THE MEDICAID PROGRAM. IF THE DENTIST OR DENTAL GROUP AGREES TO ACCEPT THE MEDICAID RECIPIENT AS A PATIENT AND INTENDS TO FILE FOR MEDICAID PAYMENT, THE ATTENDING DENTIST PROVIDING THE SERVICE MUST BE AN ENROLLED MEDICAID PROVIDER. THE ATTENDING DENTIST SHOULD SIGN AND DATE THE AMERICAN DENTAL ASSOCIATION (ADA) CLAIM FORM AND ALSO PROVIDE THEIR INDIVIDUAL PROVIDER NUMBER ON THE SIGNATURE LINE OF THE CLAIM FORM. A PRIOR AUTHORIZATION MUST ALSO BE REQUESTED UNDER THE ATTENDING DENTIST'S INDIVIDUAL CLAIM NUMBER.

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ATTENTION ALL PROVIDERS

WHEN BILLING FOR ANTIRETROVIRAL DRUG RESISTANCE TESTING IN ADULT HIV-1 INFECTION, THE FOLLOWING ARE NECESSARY FOR REVIEW OF PAYMENT: 
A. RESULTS OF THE TESTING 
B. PATIENT HISTORY WHICH WILL JUSTIFY THE TESTING.
TESTING IS RECOMMENDED IN THESE SITUATIONS ONLY:WHEN THE PATIENT PRESENTS WITH VIROLOGIC FAILURE DURING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART), OR WHEN THE
PATIENT HAS SUBOPTIMAL SUPPRESSION OF VIRAL LOAD AFTER INITIATION OF ANTIRETROVIRAL THERAPY, OR IN PREGNANCY. TESTING MAY ALSO BE CONSIDERED IN A NEWLY DIAGNOSED HIV PATIENT WHEN THE CONTACT PERSON IS KNOWN AND IS RESISTANT TO SPECIFIC DRUG(S).