PHARMACY PROVIDERS, PLEASE NOTE!!! 

PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX C:                    

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

IMPORTANT COMMUNITYCARE AND KIDMED INFORMATION

THE COMMUNITYCARE REFERRAL AND KIDMED LINKAGE AND TIMELY FILING REQUIREMENTS WERE TEMPORARILY WAIVED FOR ENROLLEES FROM THE PARISHES MOST DIRECTLY AFFECTED BY HURRICANES KATRINA AND RITA. FOR ENROLLEES FROM THE FOLLOWING PARISHES: VERMILION, CALCASIEU, ST. TAMMANY, WEST JEFFERSON, IBERIA, AND ST. MARY, THOSE WAIVERS WILL END EFFECTIVE FOR DATES OF SERVICE BEGINNING 1-1-2006. THIS MEANS THAT IF YOU PROVIDE MEDICAL CARE ON OR AFTER 1-1-2006, TO A COMMUNITYCARE ENROLLEE FROM ONE OF THE ABOVE PARISHES, AND YOU ARE NOT THE PCP OF RECORD, YOU WILL NEED A REFERRAL FROM THE PCP IN ORDER TO BE PAID BY MEDICAID. SERVICES PROVIDED TO KIDMED ENROLLEES WHO ARE NOT IN COMMUNITYCARE MUST BE PROVIDED BY THE KIDMED PROVIDER OF RECORD AND FILED WITH MEDICAID IN ACCORDANCE WITH KIDMED TIMELY FILING REQUIREMENTS. THE COMMUNITYCARE REFERRAL/KIDMED LINKAGE AND TIMELY FILING REQUIREMENTS WILL CONTINUE TO BE WAIVED FOR RECIPIENTS FROM ORLEANS, ST. BERNARD, PLAQUEMINES, EAST JEFFERSON AND CAMERON PARISHES UNTIL FURTHER NOTICE. 

ATTENTION PHARMACY PROVIDERS

THE PHARMACY BENEFITS MANAGEMENT SERVICE MANUAL IS NOW AVAILABLE AT WWW.LAMEDICAID.COM. THIS MANUAL HAS BEEN DESIGNED TO PROVIDE THE PHARMACY PROVIDER WITH THE LATEST MEDICAID POLICY IN A CONCISE AND EASY TO READ FORMAT. THE MANUAL WILL BE UPDATED AS CHANGES IN POLICY OCCUR. 

EFFECTIVE 1-1-2006, FULL BENEFIT DUAL ELIGIBLE MEDICAID RECIPIENTS WILL NO LONGER RECEIVE THEIR PHARMACY BENEFITS THROUGH THE LOUISIANA MEDICAID PHARMACY PROGRAM WITH THE EXCEPTION OF SOME DRUGS EXCLUDED FROM THE PART D BENEFIT. A DETAILED LETTER REGARDING MEDICARE PART D AS IT RELATES TO FULL BENEFIT DUAL ELIGIBLE MEDICAID RECIPIENTS IS POSTED ON THE LOUISIANA MEDICAID WEBSITE 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).