RA Messages for February 19, 2002

 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 THE 1/1/02 VERSION OF APPENDIX A:

DRUG DOSAGE STRGTH MAC EFF. DATE
AMOXICILLIN TRIHYDRATE TAB CHEW 250 MG 0.15950 01/22/02
HYDROCORTISONE LOTION 2.5% 59 ML 0.68140 01/22/02
NYSTATIN ORAL SUSP 100MU/ML 0.08500 01/22/02
PROPANOLOL HCL TABLET 20MG 0.07050 01/22/02
PROPANOLOL HCL TABLET 40 MG 0.08480 01/22/02

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

LABELER    COMPANY   BEGIN  END
65580 UPSTATE PHARMA, LLC 04/01/02   

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. 

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.

ATTENTION KIDMED/EPSDT PROVIDERS

THE CORRECT ADDRESS FOR SUBMITTING KIDMED CLAIM FORMS FOR PROCESSING BY LA MEDICAID IS :UNISYS, P.O. BOX 14849, BATON ROUGE, LA 70898-4849. PLEASE DISREGARD ANY OTHER ADDRESSES PRINTED ON CLAIM FORMS OR IN TRAINING PACKETS/MANUALS.

ALL MEDICAID PROVIDERS

EFFECTIVE NOVEMBER 15, 2001, HEMODIALYSIS SERVICES ARE EXEMPT FROM THE COMMUNITYCARE REFERRAL PROCESS. QUESTIONS REGARDING THIS CHANGE MAY BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 800-473-2783.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF PAY 2-18-02, PAYMENT FOR A SECOND COMPLETE SONOGRAM PER RECIPIENT WILL BE ALLOWED WITHIN A 270 DAY PERIOD WHEN PERFORMED BY A DIFFERENT PROVIDER.

A CLAIM MUST HAVE A DIAGNOSIS OTHER THAN V22, V22.0, V22.1, OR V22.2, BE BILLED HARDCOPY, AND HAVE ATTACHMENTS JUSTIFYING MEDICAL NECESSITY IN ORDER TO PEND FOR MEDICAL REVIEW.

NO CHANGES WERE MADE TO REMAINING PARTS OF THIS POLICY.