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

PLEASE NOTE DETAILED CHANGES TO APPENDIX A AND B AT WWW.LAMEDICAID.COM.

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 PROVIDERS

THE IMPLEMENTATION OF THE FORM CMS 1500 (0805) WILL BE DELAYED. PLEASE CONTINUE TO MONITOR THE WEBSITE AND RA MESSAGES FOR UPDATED INFORMATION.

ATTENTION DENTAL PROVIDERS
2006 AMERICAN DENTAL ASSOCIATION CLAIM FORM (HARDCOPY)

EFFECTIVE 01/01/07, MEDICAID WILL BEGIN ACCEPTING THE NEW 2006 AMERICAN DENTAL ASSOCIATION (ADA) CLAIM FORM FROM PROVIDERS WHO SUBMIT HARDCOPY CLAIMS TO MEDICAID FOR PRIOR AUTHORIZATION AND PAYMENT OF DENTAL SERVICES. MEDICAID WILL ALSO CONTINUE TO ACCEPT THE 2002 AND 2004 ADA CLAIM FORMS THROUGH 04/01/07. EFFECTIVE 04/02/07, THE 2006 ADA CLAIM FORM WILL BE REQUIRED WHEN SUBMITTING HARDCOPY CLAIMS TO MEDICAID AND
WILL BE THE ONLY CLAIM FORM ACCEPTED FOR PRIOR AUTHORIZATION AND PAYMENT OF DENTAL SERVICES. ADDITIONAL IMPORTANT INFORMATION ON THIS TOPIC IS LOCATED ON THE FOLLOWING WEBSITE: WWW.LAMEDICAID.COM (GO TO LINK ENTITLED "NEW MEDICAID INFORMATION" OR "BILLING INFORMATION".) PROVIDERS SHOULD CHECK THIS WEBSITE PERIODICALLY FOR NEW UPDATES.

MEDICAID IMPLANON UPDATE

LOUISIANA MEDICAID IS IN THE PROCESS OF IMPLEMENTING THE PROGRAMMING AND POLICY NECESSARY TO ADD BOTH THE CONTRACEPTIVE IMPLANT, IMPLANON, AND THE PROCEDURE CODING FOR ITS INSERTION/REMOVAL TO OUR FILES. PROVIDERS SHOULD MONITOR FUTURE RA MESSAGES FOR FURTHER INFORMATION AS TO WHEN THIS PROCESS IS COMPLETE AND CLAIMS MAY BE SUBMITTED.

ALL PROVIDERS

EFFECTIVE 02/01/07, CLAIMS WITH INVALID ICD-9 DIAGNOSIS AND SURGICAL PROCEDURE CODES WILL DENY FOR ERROR CODE 433. PLEASE SEE THE LAMEDICAID WEBSITE HOME PAGE FOR MORE INFORMATION.

ATTENTION EPSDT PSYCHOLOGICAL AND BEHAVIORAL SERVICES PROVIDERS

EFFECTIVE 12/18/06, RATES FOR SERVICES IN THE EPSDT PSYCHOLOGICAL AND BEHAVIORAL SERVICES PROGRAM HAVE BEEN INCREASED PENDING APPROVAL BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). THE NEW FEE SCHEDULE CAN BE FOUND AT WWW.LAMEDICAID.COM (SEE FEE SCHEDULES LINK). SHOULD YOU HAVE ANY QUESTIONS RELATED TO THIS MATTER, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225)924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
EFFECTIVE APRIL 2007 NATIONAL DRUG CODES REQUIRED ON PHYSICIAN
ADMINISTERED DRUG CLAIMS

THE DEFICIT REDUCTION ACT OF 2005 (DRA) INCLUDES PROVISIONS REGARDING PHYSICIAN-ADMINISTERED DRUGS AND THE COLLECTION OF MEDICAID DRUG REBATES FROM MANUFACTURERS. CURRENTLY PHYSICIAN-ADMINISTERED DRUGS ARE BILLED TO MEDICAID USING HCPCS CODES. IN ORDER TO SECURE REBATES FROM PHYSICIAN ADMINISTERED DRUGS, THE FEDERAL STATUTE IS REQUIRING THE USE OF NATIONAL DRUG CODES (NDC) FOR DRUG PRODUCTS ADMINISTERED IN THE PHYSICIAN'S OFFICE. THE NDC NUMBER AND HCPCS CODE FOR DRUG PRODUCTS WILL BE REQUIRED ON BOTH THE 837P (ELECTRONIC FORM) AND THE CMS-1500 (PAPER FORM). THIS REQUIREMENT WILL BEGIN WITH IMPLEMENTATION OF THE NEW CMS-1500 FORM. PROVIDERS MUST UPDATE THEIR BILLING SOFTWARE TO ENSURE THAT THESE FEDERAL REQUIREMENTS ARE MET. PROVIDERS SHOULD MONITOR WWW.LAMEDICAID.COM FOR SPECIFIC POLICY AND BILLING INSTRUCTIONS.

ATTENTION DENTAL PROVIDERS - 2007 DENTAL CODING CHANGES

EFFECTIVE FOR DATES OF SERVICE ON OR AFTER 1/1/2007, THE FOLLOWING 3 NEW DENTAL PROCEDURE CODES WILL BE REIMBURSABLE BY MEDICAID IN THE EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT (EPSDT) DENTAL PROGRAM: D0145, D1206 AND D1555. THESE THREE PROCEDURE CODES WILL NOT REQUIRE PRIOR AUTHORIZATION BY MEDICAID. APPLICABLE POLICY FOR EACH PROCEDURE CODE IS PROVIDED ON THE WWW.LAMEDICAID.COM WEBSITE UNDER THE
LINKS ENTITLES "NEW MEDICAID INFORMATION" OR "BILLING INFORMATION." PLEASE NOTE THAT THERE WILL BE A DELAY IN REIMBURSEMENT OF THESE THREE CODES DUE TO PROGRAMMING REQUIREMENTS. ONCE THE REQUIRED PROGRAMMING CHANGES ARE MADE, MEDICAID WILL AUTOMATICALLY RECYCLE DENIED CLAIMS FOR THESE 3 CODES FOR DATES OF SERVICE BETWEEN 1/1/2007 AND THE DATE OF IMPLEMENTATION OF THE PROGRAMMING CHANGES. PLEASE REFER TO THE REVISED EPSDT DENTAL PROGRAM FEE SCHEDULE (REVISION DATE JANUARY 1, 2007) WHICH IS LOCATED AT WWW.LAMEDICAID.COM FOR COMPLETE FEE INFORMATION.

ATTENTION ALL PROVIDERS

LOUISIANA MEDICAID IS IN THE PROCESS OF COMPLETING THE PROGRAMMING FOR THE 2007 HCPCS CODE UPDATES. THIS INCLUDES BOTH NEW AND DELETED CODES FOR 2007. PROVIDERS SHOULD MONITOR FUTURE RA MESSAGES FOR NOTIFICATION OF THE IMPLEMENTATION DATE FOR USE OF NEW 2007 HCPCS CODES.