PHARMACY PROVIDERS, PLEASE NOTE!!!
PLEASE BE ADVISED THAT AN UPDATED LISTING OF
APPENDIX A,B, AND C IS AVAILABLE AT WWW.LAMEDICAID.COM.
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
CLAIMS FOR PAYMENT OF PRIMARY AMALGAMS (D2140, D2150, AND D2160 - TEETH
A THROUGH T) WERE INCORRECTLY REIMBURSED FOR DATES OF SERVICE JANUARY 1,2006 THROUGH JANUARY 13, 2006. A SYSTEM RECYCLE WILL OCCUR ON THE
REMITTANCE ADVICE DATED JANUARY 24, 2006 IN ORDER TO RECOVER THE OVERPAYMENT FOR THESE SERVICES. SHOULD YOU HAVE ANY QUESTIONS, YOU MAY
CONTACT THE MEDICAID DENTAL UNIT BY CALLING 225-216-6470.
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.
OUTPATIENT VISIT LIMIT CHANGE TO CALENDAR
YEAR
EFFECTIVE IMMEDIATELY, THE NUMBER OF REMAINING 2006 OUTPATIENT VISITS
REFLECTED ON THE REVS, MEVS, AND E-MEVS SYSTEMS WILL BE BASED ON CALENDAR YEAR. (JANUARY 1 - DECEMBER 31)
PROVIDERS WILL BE NOTIFIED WHEN PROGRAMMING HAS BEEN COMPLETED TO
CORRECTLY REFLECT THE REMAINING OUTPATIENT VISITS FOR DATES OF SERVICE JULY 1 - DECEMBER 31, 2005, ON REVS, MEVS, AND
E-MEVS.
CLAIMS IMPROPERLY DENIED FOR EXCEEDING THE MAXIMUM NUMBER OF VISITS
DURING THE CHANGE FROM STATE FISCAL YEAR TO CALENDAR YEAR HAVE BEEN RECYCLED AND WILL APPEAR ON THE REMITTANCE ADVICE OF JANUARY 31, 2006.
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.
ALL PROVIDERS
THE UNISYS AUTOMATED VOICE RESPONSE SYSTEM (REVS) WILL BE UNAVAILABLE
SATURDAY, FEBRUARY 11, 2006 FOR A PLANNED SOFTWARE UPGRADE. THE SYSTEM WILL BE DOWN STARTING AT 8:00 AM AND BECOME FUNCTIONAL LATER IN THE
AFTERNOON (APPROXIMATELY 2:00 PM). EMEVS AND MEVS WILL BE AVAILABLE FOR USE.