PHARMACY PROVIDERS, PLEASE NOTE!!!
EFFECTIVE FEBRUARY 20, 2006 THE DEPT OF HEALTH
& HOSPITAL, OFFICE OF SECRETARY, BUREAU OF HEALTH SERVICES FINANCING WILL
REDUCE THE ESTIMATED ACQUISITION COST REIMBURSEMENT RATE UNDER THE MEDICAID
PROGRAM FOR ANTIHEMOPHILIA DRUGS, FACTOR PRODUCTS, TO THE AVERAGE WHOLESALE
PRICE MINUS 30 PERCENT FOR ALL PRESCRIPTION DRUG PROVIDERS.
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 DENTAL PROVIDERS
SOME CLAIMS FOR PAYMENT OF ROOT CANAL THERAPY, BICUSPID(D3320) FOR TEETH
NUMBERS 28 AND 29; AND ROOT CANAL THERAPY, MOLAR(D3330)FOR TEETH NUMBERS
30 AND 31 WHICH WERE RECEIVED BY MEDICAID BETWEEN THE DATES OF NOVEMBER 1, 2005 THROUGH JANUARY 20, 2006 DENIED IN ERROR WITH DENIAL CODE 917
(LIFETIME LIMITS FOR THIS SERVICE HAVE BEEN EXCEEDED). THE PROBLEM CAUSING THE DENIAL
HAS BEEN RESOLVED AND THE AFFECTED CLAIMS WILL BE RECYCLED BY MEDICAID FOR PAYMENT IN THE NEAR FUTURE. THESE TRANSACTIONS
WILL APPEAR ON YOUR REMITTANCE ADVICE. IF YOU HAVE ANY QUESTIONS, YOU MAY CONTACT THE
MEDICAID DENTAL UNIT BY CALLING 225-216-6470.
ALL PROVIDERS
LA MEDICAID RECENTLY INFORMED PROVIDERS THAT THE 2006 ICD-9-CM DISEASE
AND PROCEDURE CLASSIFICATION UPDATE WAS COMPLETE AND THAT VALID CODES MUST BE USED ON CLAIM SUBMISSIONS WITH DOS 10-1-05 FORWARD. DELETED OR
INVALID CODES WERE PLACED IN NON-PAY STATUS, RESULTING IN DENIAL ERROR 433. TO ALLOW PROVIDERS TO MAKE NECESSARY CHANGES IN THEIR CLAIM SYSTEMS,
ERROR 433 WILL BE 'EDUCATIONAL ONLY' FOR CLAIMS WITH INVALID CODES UNTIL MARCH 1, 2006. FOLLOWING THE GRACE PERIOD AND PROVIDER NOTIFICATION,
CLAIMS WILL AGAIN DENY WITH ERROR 433.FOR INFORMATION REGARDING ICD-9-CM OFFICIAL GUIDELINES FOR CODING AND REPORTING, PROVIDERS MAY ACCESS THE
CMS WEBSITE AT HTTP://WWW.CMS.HHS.GOV/ICD9PROVIDERDIAGNOSTICCODES/
ALL PROVIDERS
LOUISIANA MEDICAID IS IN THE PROCESS OF COMPLETING THE PROGRAMMING FOR
THE 2006 HCPCS CODE UPDATES WHICH INCLUDES NEW AND DELETED CODES. PLEASE MONITOR FUTURE RA MESSAGES FOR NOTIFICATION OF THE IMPLEMENTATION DATE
FOR USE OF THE 2006 HCPCS CODES BY LOUISIANA MEDICAID.
ATTENTION PROVIDERS AND SUBMITTERS OF ELECTRONIC
CLAIMS
THE DEADLINE FOR RECEIVING 2005 AND 2006 ANNUAL CERTIFICATION FORMS HAS
PASSED. IF YOU HAVE NOT SUBMITTED A CERTIFICATION FORM FOR YOU SUBMITTER NUMBER (BEGINNING WITH 450), IMMEDIATE ACTION IS REQUIRED. FAILURE TO
SUBMIT THE REQUIRED FORM WILL RESULT IN DEACTIVATION OF THE SUBMITTER NUMBER. IF A NUMBER IS DEACTIVATED, THE CERTIFICATION FORM WILL HAVE TO
BE RECEIVED IN THE UNISYS EDI DEPARTMENT HARDCOPY (NO FAXES) BEFORE THE NUMBER IS
REACTIVATED. THIS WILL RESULT IN A DELAY IN PAYMENT FOR YOUR PROVIDERS. PROVIDERS SHOULD VERIFY WITH THEIR SUBMITTER THAT THIS
REQUIREMENT HAS BEEN MET TO ENSURE NO DELAYS IN CLAIMS PAYMENT.
STERILIZATION CONSENT CLARIFICATION
IN ORDER TO FACILITATE CORRECT SUBMISSION OF THE STERILIZATION CONSENT
WHEN A PREMATURE DELIVERY OCCURS, THE FOLLOWING CLARIFICATION IS PROVIDED.
"PREMATURITY" IS DEFINED AS THE STATE OF AN INFANT BORN PRIOR TO THE 37TH WEEK OF GESTATION. PHYSICIANS SHOULD USE THIS DEFINITION IN
THE COMPLETION OF THE STERILIZATION CONSENT WHEN PREMATURE DELIVERY IS A FACTOR.
NOTICE TO PROVIDERS OF PROFESSIONAL
SERVICES
EFFECTIVE WITH THE DATE OF SERVICE JANUARY 1, 2006, THE FOLLOWING CPT
CODES WILL BE ADDED TO THE LIST OF CODES WHICH REQUIRE A QW MODIFIER.
80178
86880
83037
82271