RA Messages for February 27, 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 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 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 DENTAL PROVIDERS

EFFECTIVE 4/2/07, THE 2006 ADA CLAIM FORM WILL BE REQUIRED WHEN SUBMITTING HARDCOPY DENTAL CLAIMS TO MEDICAID FOR PAYMENT AND PRIOR AUTHORIZATION. REFER TO WWW.LAMEDICAID.COM UNDER "NEW MEDICAID INFORMATION" FOR ADDITIONAL DETAILS.

ATTENTION COMMUNITYCARE PROVIDERS WITH CHANGES TO PROVIDER NUMBERS
IMMUNIZATION PAY-FOR-PERFORMANCE

COMMUNITYCARE PCPS WHO HAVE HAD A CHANGE IN THEIR MEDICAID PROVIDER # DUE TO A CHANGE IN THEIR PROVIDER TYPE (INDIVIDUAL NUMBER TO GROUP, GROUP NUMBER TO RHC, ETC.) THAT WAS EFFECTIVE 7/1/2006 OR AFTER AND ARE INTERESTED IN PARTICIPATING IN THE IMMUNIZATION PAY-FOR-PERFORMANCE (P4P) INITIATIVE SHOULD NOTE THE FOLLOWING IMPORTANT INSTRUCTIONS:

TO ENSURE ACCURATE IDENTIFICATION OF APPROPRIATE IMMUNIZATION RECORDS, THE P4P REGISTRATION PROCESS MUST BE COMPLETED FOR EACH COMMUNITYCARE PCP PROVIDER NUMBER (PREVIOUS AND CURRENT) THAT HAD LINKAGES FOR RECIPIENTS UNDER THE AGE OF 21 YEARS OLD.

TO BE ELIGIBLE FOR PARTICIPATION IN P4P RETROACTIVE TO 7/1/2006, THE REGISTRATION PROCESS MUST BE COMPLETED BY 3/11/2007.THE P4P REGISTRATION MUST BE COMPLETED ON THE WWW.LAMEDICAID.COM SECURED WEBSITE.

ATTENTION PROVIDERS - RECIPIENT FRAUD AND ABUSE

THE UNAUTHORIZED USE OF A LOUISIANA MEDICAID CARD CONSTITUTES RECIPIENT FRAUD. THE MISREPRESENTATION OF FACTS IN ORDER TO BECOME OR TO REMAIN ELIGIBLE TO RECEIVE BENEFITS IS GROUNDS FOR RECIPIENT FRAUD REFERRAL. IN CASES OF FRAUD OR ABUSE, PROVIDERS SHOULD CONTACT THE MEDICAID FRAUD HOTLINE AT 1-800-488-2917.

ATTENTION PROVIDERS

THE IMPLEMENTATION OF THE NEW UB04 FORM WILL BE DELAYED. PLEASE DO NOT SUBMIT THIS NEW FORM UNTIL NOTIFIED. IF THE NEW UB04 FORM IS SUBMITTED, YOUR CLAIM WILL BE REJECTED. PLEASE CONTINUE TO MONITOR THE WEBSITE AND RA MESSAGES FOR UPDATED INFORMATION.

ATTENTION PROVIDERS

EFFECTIVE 2/9/2007, THE DEPARTMENT OF HEALTH AND HOSPITALS HAS IMPLEMENTED THE $2.00 WAGE PASS-THROUGH FOR DIRECT CARE WORKERS IN SPECIFIC LONG TERM CARE SERVICES, INCLUDING NURSING FACILITIES, ICF/DD, LT-PCS AND CERTAIN HOME AND COMMUNITY-BASED WAIVERS. ADDITIONAL INFORMATION ON IMPLEMENTING THE INCREASE, AS WELL AS THE REQUIRED FORMS AND INSTRUCTIONS FOR REPORTING MAY BE FOUND ON THE WEB AT WWW.LAMEDICAID.COM