RA Messages for February 6, 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 
13453 GATEWAY PHARMACEUTICALS,LLC.   04/01/07
38130 EMREX/ECONOMED PHARMACEUTICALS,INC.   04/01/07
47028 SENECA PHARMACEUTICALS, INC.   04/01/07
67754 HARVEST PHARMACEUTICALS,INC.    

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 ALL PROVIDERS

IF YOU RECEIVED FUNDS/PAYMENTS FROM BOTH MEDICAID AND THE HURRICANE RELATED UNCOMPENSATED CARE POOL (UCC), YOU WILL RECEIVE TWO 1099S FROM UNISYS - ONE FOR MEDICAID PAYMENTS AND ONE FOR UCC PAYMENTS. PLEASE BE AWARE OF THIS AS YOU COLLECT DOCUMENTS FOR TAX PREPARATION.

ATTENTION COMMUNITYCARE PROVIDERS

LOUISIANA MEDICAID WILL BE IMPLEMENTING IMMUNIZATION PAY-FOR-PERFORMANCE SUPPLEMENTAL PAYMENTS TO COMMUNITYCARE PCPS. THESE PAYMENTS WILL BE BASED ON THE PERCENTAGE OF 24 MONTH OLD RECIPIENTS LINKED TO THE PCP THAT ARE UP-TO-DATE WITH ALL RECOMMENDED IMMUNIZATIONS; AND THE PROVIDER'S ENROLLMENT IN AND UTILIZATION OF THE LOUISIANA IMMUNIZATION NETWORK FOR KIDS STATEWIDE (LINKS) IMMUNIZATION REGISTRY AND VACCINES FOR CHILDREN (VFC) PROGRAM. DETAILED INFORMATION REGARDING THE IMMUNIZATION PAY-FOR-PERFORMANCE PAYMENTS CAN BE FOUND AT WWW.LAMEDICAID.COM.

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 PROVIDERS - RECIPIENT FRAUD AND ABUSE

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

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 HOSPITALS - TREATMENT AND OBSERVATION ROOM CHARGES

EFFECTIVE FOR DATES OF SERVICE ON OR AFTER MARCH 1, 2007, REVENUE CODES 760 AND 769 WILL NO LONGER BE VALID FOR THE BILLING OF EITHER TREATMENT OR OBSERVATION ROOM CHARGES.

WHEN BILLING FOR USE OF A TREATMENT ROOM, HOSPITALS ARE DIRECTED TO BILL REVENUE CODE 761 WITH THE APPROPRIATE HCPC CODE FOR THE SERVICE PROVIDED.

OBSERVATION ROOM CHARGES MUST BE BILLED UTILIZING REVENUE CODE 762 WITH THE APPROPRIATE HCPC CODE FOR THE SERVICE PROVIDED AND THE NUMBER OF UNITS PROVIDED. EACH UNIT REPRESENTS ONE HOUR OF OBSERVATION. HOSPITALS MUST INCLUDE THE ADMISSION HOUR AND DISCHARGE HOUR WHEN BILLING FOR THESE SERVICES ON ALL OUTPATIENT CLAIMS. POLICY MANDATES OUTPATIENT SERVICES EXCEEDING 24 HOURS IN DURATION ARE 'DEEMED' INPATIENT, EVEN IF THE PATIENT IS ADMITTED AS OUTPATIENT. THEREFORE CLAIMS WHICH INCLUDE OBSERVATION UNITS (HOURS) OF GREATER THAN 24 MUST BE BILLED AS INPATIENT AND CANNOT BE SPLIT BILLED AS INDIVIDUAL OUTPATIENT CLAIMS.