RA Messages for February 13, 2007

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 
PROMETHAZINE SUPPOSITORY 50MG OFF MAC 1/24/07

PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX C: 

LABELER COMPANY  BEGIN END 
00044 KNOLL PHRAMACEUTICAL COMPANY    04/01/07
00214 GLAXOSMITHKLINE    04/01/07
00905 PFIZER, INC   04/01/07
13453 GATEWAY PHARMACEUTICALS,LLC 04/01/07  
15210  OTN GENERICS, INC 01/01/07  
17433  DBA ENEMEEZ, INC 04/01/07  
20091 PROVIDENT PHARMACEUTICAL, INC. 04/01/07  
38130 EMREX/ECONOMED PHARMACEUTICALS, INC   04/01/07
47028 SENECA PHARMACEUTICALS, INC.   04/01/07
58407 MAGNA PHARMACEUTICALS, INC.    04/01/07
58437 GLAXOSMITHKLINE    04/01/07
58521 SHIRE US. INC     04/01/07
67754 HARVEST PHARMACEUTICALS,INC.   04/01/07
74684 GLAXOSMITHKLINE   04/01/07

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 ALL PROVIDERS

MEDICAID HAS RECYCLED THE CLAIMS SUBMITTED AND SUBSEQUENTLY DENIED PRIOR TO THE LOADING OF THE 2007 ICD-9 DIAGNOSIS CODES TO THE MEDICAID SYSTEM. THIS RECYCLE APPEARED ON THE REMITTANCE ADVICE DATED 1/23/2007.

ATTENTION PROVIDERS

THE DEADLINE FOR SUBMITTING CLAIMS RELATED TO THE TPL RECOUPMENTS OF 04/12/05 AND 11/29/05 WAS JULY 15, 2006. ALTHOUGH WE CONTINUED TO ACCEPT AND REVIEW SOME OUTSTANDING CLAIMS AFTER THAT DEADLINE, THIS PROJECT IS NOW CLOSED, AND NO FURTHER CLAIMS WILL BE REVIEWED OR CONSIDERED FOR PROCESSING. PLEASE DISCONTINUE SUBMITTING CLAIMS RELATED TO THESE RECOUPMENTS TO DHH AND UNISYS.

ATTENTION HOSPITALS - AMBULATORY SURGERY GROUPS

SINCE THE IMPLEMENTATION OF THE 3/1/05 REQUIREMENT OF REVENUE CODE 490 TO UTILIZE HCPC CODES, DHH HAS BEEN REVIEWING HCPC CODES FOR POSSIBLE ADDITION TO THE AMBULATORY SURGERY GROUPS. DHH HAS COMPLETED THE REVIEW OF SURGICAL HCPC CODES, INCLUDING ADDITIONS AND DELETIONS OF THE 2006 & 2007 HCPC CODES. A COMPLETE COPY OF THIS LIST CAN BE FOUND BY ACCESSING THE MEDICAID WEBSITE AT WWW.LAMEDICAID.COM LOCATED UNDER THE FEE SCHEDULES HEADING.


CLAIMS WHICH WERE SUBMITTED TIMELY USING REVENUE CODE 490 WILL FALL INTOONE OF TWO CATEGORIES, EITHER THE HCPC CODE HAS BEEN ADDED TO THE AMB-SURG LIST AND THE CLAIM NEEDS TO BE RESUBMITTED OR THE HCPC CODE HAS NOT BEEN ADDED AND THE CLAIM MUST BE CORRECTED UTILIZING THE APPROPRIATE REVENUE CODE AND RESUBMITTED. EITHER WAY, THE CLAIM MUST BE SUBMITTED WITH PROOF OF TIMELY FILING.

ALL CLAIMS WITH PROOF OF TIMELY FILING MUST BE RECEIVED WITH A REQUEST FOR OVERRIDE NO LATER THAN CLOSE OF BUSINESS ON APRIL 2, 2007. PLEASE SEND TO DHH, ATTN: DARLENE WHITE, P.O. BOX 91030, BATON ROUGE, LA 70821.CLAIMS RECEIVED AFTER THIS DATE WILL NOT BE CONSIDERED FOR PAYMENT.

ATTENTION COMMUNITYCARE PROVIDERS

EFFECTIVE 2-9-2006 COMMUNITYCARE PCPS INTERESTED IN THE IMMUNIZATION PAY-FOR-PERFORMANCE(P4P) INITIATIVE CAN BEGIN REGISTERING TO PARTICIPATE BY USING THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM. REGISTRATION FOR P4P CAN BE COMPLETED ONLY THROUGH THIS WEBSITE. PROVIDERS ARE TO LOGIN USING THE ESTABLISHED LOGIN PROCEDURES USING "PROVIDER LOGIN." ONCE LOGGED IN, FOLLOW THE INSTRUCTIONS IN THE IMMUNIZATION PAY-FOR-PERFORMANCE (P4P) LINK. TO QUALIFY FOR PARTICIPATION IN P4P RETROACTIVE TO JULY 1, 2006, COMMUNITYCARE PCPS WILL HAVE THROUGH 3-11-2007 TO COMPLETE THE P4P REGISTRATION PROCESS. PCPS THAT REGISTER AFTER 3-11-2007 WILL NOT BE ELIGIBLE FOR RETROACTIVE PARTICIPATION BUT WILL BE ELIGIBLE TO PARTICIPATE IN P4P STARTING WITH THE MONTH THEIR REGISTRATION IS COMPLETED (EXCEPT PCPS WITH REGISTRATIONS FROM 3-12 TO
3-31-2007 WHO WILL BE ELIGIBLE FOR PARTICIPATION IN P4P STARTING 4-1-2007). DETAILS, INCLUDING CONTACT INFORMATION, CAN BE FOUND AT THE P4P LINK MENTIONED ABOVE.

ATTENTION ALL PROVIDERS

AS PREVIOUSLY COMMUNICATED, THE IMPLEMENTATION OF THE NEW CMS 1500 (08/05) CLAIM FORM HAS BEEN DELAYED. FOR ALL PROVIDERS WHO HAVE SUBMITTED CLAIMS ON THE NEW CLAIM FORM, THEY WILL BE HELD BY UNISYS UNTIL THE IMPLEMENTATION OF THE NEW PROGRAMMING. NO ADDITIONAL ACTION IS REQUIRED BY THE PROVIDER AT THIS TIME. ONCE THE PROGRAMMING IS IN PLACE, THE CLAIMS WILL BE PROCESSED AS USUAL. FUTURE RA MESSAGES WILL COMMUNICATE THE IMPLEMENTATION OF THIS NEW CLAIM FORM. FOR QUESTIONS, PLEASE CONTACT UNISYS PROVIDER RELATIONS AT 800/473-2783 OR 225/924-5040.