RA Messages for March 20, 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 NOTE THE FOLLOWING CHANGES TO APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 14290 |
TRIAX PHARMACEUTICALS, LLC |
07/01/07 |
|
| 23635 |
MALLINCKRODT BRAND PHARMACEUTICALS,INC |
07/01/07 |
|
| 24839 |
SJ PHARMACEUTICALS,LLC |
04/01/07 |
|
| 49230 |
FRESENIUS MEDICAL CARE NORTH AMERICA |
04/01/07 |
|
| 54738 |
RICHMOND PHARMACEUTICALS,INC |
|
07/01/07 |
| 61646 |
IOPHARM LABORATORIES, INC. |
|
04/01/07 |
| 66220 |
CUMBERLAND PHARMA000006 |
07/01/07 |
|
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 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 PHYSICIANS - IMPLANON
IMPLANT POLICY
EFFECTIVE WITH DATES OF SERVICE AUGUST
9, 2006 FORWARD, THE FOLLOWING REIMBURSEMENT POLICY APPLIES TO THE
INSERTION AND REMOVAL OF THE IMPLANON (ETONOGESTREL) IMPLANT:
CLINICALLY TRAINED PROVIDERS OBTAIN
THE CONTRACEPTIVE IMPLANT (ONE PER RECIPIENT PER 3 YEARS) FROM A
SPECIALTY PHARMACY AUTHORIZED BY THE MANUFACTURER. THE PHYSICIAN WILL
NOT BE REIMBURSED BY MEDICAID FOR THE IMPLANT ITSELF. THE IMPLANT WILL
BE REIMBURSED AS A PHARMACY BENEFIT. PROVIDER CLAIMS FOR THE INSERTION,
REMOVAL, OR REMOVAL WITH REINSERTION OF THE IMPLANT ARE TO BE SUBMITTED
USING THE APPROPRIATE CPT (11981-
11983) AND DIAGNOSIS (V25.5, V25.43, OR V45.52) CODES. IF NATIONALLY
APPROVED CHANGES OCCUR TO DIAGNOSES OR CPT CODES THAT RELATE TO THIS
IMPLANT AT A FUTURE DATE, PROVIDERS ARE TO USE THE MOST ACCURATE CODING
AVAILABLE FOR THE PARTICULAR DATE OF SERVICE. {OTHER PROCEDURAL AND
DIAGNOSIS CODES MAY ALSO BE APPROPRIATE ON THIS DATE OF SERVICE, AND
PROVIDERS ARE TO USE THE CODES THAT MOST ACCURATELY DESCRIBE THE
SERVICE(S) PROVIDED.}
CLAIMS SUBMITTED FOR THIS
CONTRACEPTIVE IMPLANT AND ITS INSERTION IN EXCESS OF THE MANUFACTURER'S
RECOMMENDED GUIDELINES ARE SUBJECT TO REVIEW AND ACTION BY THE
DEPARTMENT. DOCUMENTATION IN THE PHYSICIAN'S RECIPIENT RECORD IS TO
INCLUDE EVIDENCE
OF RECIPIENT EDUCATION REGARDING THIS LONG-ACTING CONTRACEPTIVE.
ATTENTION PROVIDERS
THE FORM CMS-1500 (08-05) WILL BE
ACCEPTED BY LOUISIANA MEDICAID FOR ALL DATES OF SUBMISSION BEGINNING
MARCH 5, 2007, BUT WILL NOT BE MANDATED FOR USE UNTIL JUNE 4, 2007.
PROVIDERS WILL BE PERMITTED TO USE
EITHER THE CURRENT FORM CMS-1500 (12-90) OR THE REVISED FORM
CMS-1500(08-05) BEGINNING MARCH 5, 2007 THROUGH JUNE 3, 2007.
EFFECTIVE JUNE 4, 2007, THE FORM
CMS-1500 (12-90) WILL BE DISCONTINUED AND ONLY THE FORM CMS-1500 (08-05)
SHALL BE USED. THIS INCLUDES ALL REBILLING OF CLAIMS EVEN THOUGH EARLIER
SUBMISSIONS MAY HAVE BEEN ON THE FORM CMS-1500 (12-90).
ATTENTION PROVIDERS
EFFECTIVE IMMEDIATELY, IN ADDITION TO
MEETING NURSING FACILITY LEVEL OF CARE, ONLY PEOPLE WHO RESIDE IN
NURSING HOMES OR THOSE WHO ARE AT IMMINENT RISK FOR NEEDING NURSING HOME
CARE IN THE NEXT 120 DAYS WILL BE ELIGIBLE FOR THE ADULT DAY HEALTH CARE
WAIVER, LONG TERM PERSONAL CARE SERVICES AND THE ELDERLY AND DISABLED
ADULT WAIVER. THIS POLICY IS BEING IMPLEMENTED IN ACCORDANCE WITH THE
COURT-APPROVED SETTLEMENT AGREEMENT IN BARTHELEMY V. LOUISIANA DEPT. OF
HEALTH AND HOSPITALS ET AL. THE INFORMATION COLLECTED DURING THE LEVEL
OF CARE SCREENING PROCESS WILL BE USED TO DETERMINE WHETHER NURSING HOME
ADMISSION IS IMMINENT. ONLY NEW APPLICANTS WILL BE SCREENED FOR IMMINENT
RISK CRITERIA. PERSONS CURRENTLY APPROVED TO RECEIVE THESE THREE HOME
AND COMMUNITY-BASED SERVICES ARE PRESUMED TO BE AT IMMINENT RISK OF
NURSING HOME ADMISSION AND WILL MAINTAIN THEIR ELIGIBILITY AND CONTINUE
TO RECEIVE THE SERVICES.
THIS SCREENING WILL BE DONE BY ACS OR
THE OAAS REGIONAL OFFICE PRIOR TO LINKAGES TO PROVIDERS. THEREFORE,
THERE IS NO NEED FOR PROVIDERS OR SUPPORT COORDINATORS TO ALTER ANY OF
THEIR CURRENT PROCEDURES OR PROCESSES.
NATIONAL PROVIDER IDENTIFIER
DHH HAS LAUNCHED A NEW NPI WEB
REGISTRATION SITE FOR PROVIDERS TO REGISTER THEIR NPI WITH LOUISIANA
MEDICAID. CMS WILL REQUIRE ALL HIPAA STANDARD TRANSACTIONS, INCLUDING
MEVS ELIGIBILITY INQUIRY AND CLAIMS STATUS INQUIRY TO BE SUBMITTED USING
THE NPI NUMBER BEGINNING 23-MAY-07.THE NEW NPI APPLICATION IS ACCESSIBLE
FROM THE LIST OF APPLICATIONS IN THE SECURED PROVIDER AREA OF THE
WWW.LAMEDICAID.COM WEB SITE. FIND THIS AND MORE ON THE NPI INFORMATION
PAGE ACCESSIBLE FROM WWW.LAMEDICAID.COM>
HIPAA INFORMATION CENTER>NATIONAL PROVIDER IDENTIFIER (NPI).