PHARMACY PROVIDERS, PLEASE NOTE!!! 

PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX A:  

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 DENTAL PROVIDERS

CLAIMS FOR PAYMENT OF PRIMARY AMALGAMS (D2140, D2150, AND D2160 - TEETH A THROUGH T) WERE INCORRECTLY REIMBURSED FOR DATES OF SERVICE JANUARY 1,2006 THROUGH JANUARY 13, 2006. A SYSTEM RECYCLE WILL OCCUR ON THE REMITTANCE ADVICE DATED JANUARY 24, 2006 IN ORDER TO RECOVER THE OVERPAYMENT FOR THESE SERVICES. SHOULD YOU HAVE ANY QUESTIONS, YOU MAY CONTACT THE MEDICAID DENTAL UNIT BY CALLING 225-216-6470.

OUTPATIENT VISIT LIMIT CHANGE TO CALENDAR YEAR

EFFECTIVE IMMEDIATELY, THE NUMBER OF REMAINING 2006 OUTPATIENT VISITS REFLECTED ON THE REVS, MEVS, AND E-MEVS SYSTEMS WILL BE BASED ON CALENDAR YEAR. (JANUARY 1 - DECEMBER 31) 

PROVIDERS WILL BE NOTIFIED WHEN PROGRAMMING HAS BEEN COMPLETED TO CORRECTLY REFLECT THE REMAINING OUTPATIENT VISITS FOR DATES OF SERVICE JULY 1 - DECEMBER 31, 2005, ON REVS, MEVS, AND E-MEVS. 

CLAIMS IMPROPERLY DENIED FOR EXCEEDING THE MAXIMUM NUMBER OF VISITS DURING THE CHANGE FROM STATE FISCAL YEAR TO CALENDAR YEAR HAVE BEEN RECYCLED AND WILL APPEAR ON THE REMITTANCE ADVICE OF JANUARY 31, 2006. 

ALL PROVIDERS

THERE WAS A CLAIMS PROCESSING ERROR ASSOCIATED WITH CERTAIN CLAIMS THAT 
PREVIOUSLY PENDED AND/OR DENIED FOR ERROR CODE 495. WE HAVE RECYCLED THESE CLAIMS SO THAT THEY WILL PROCESS CORRECTLY AND THE RESULTS APPEAR ON THIS REMITTANCE ADVICE.