RA Messages for March 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 NOTE THE FOLLOWING CHANGES TO APPENDIX C: 

LABELER COMPANY BEGIN  END 
00689 JMI-DANIELS PHARMACEUTICALS, INC.   07/01/07
00766 GLAXOSMITHKLINE   07/01/07
14290 TRIAX PHARMACEUTICALS, LLC 07/01/07  
17518 3M PHARMACEUTICAL   07/01/07
20694 MYOGEN, INC   07/01/07
23635 MALLINCKRODT BRAND PHARMACEUTICALS,INC 07/01/07  
24839 SJ PHARMACEUTICALS,LLC 04/01/07  
45800 GLAXOSMITHKLINE   07/01/07
49230 FRESENIUS MEDICAL CARE NORTH AMERICA 04/01/07  
49692 GLAXOSMITHKLINE   07/01/07
53100 GLAXOSMITHKLINE   07/01/07
54738 RICHMOND PHARMACEUTICALS,INC   07/01/07
55298 3M PHARMACEUTICALS   07/01/07
61646 IOPHARM LABORATORIES, INC.   04/01/07
61799 THE LIPOSOME COMPANY, INC   07/01/07
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 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.

ATTENTION SUPPORTS WAIVER PROVIDERS

THIS IS TO ADVISE THAT THE DEPT. OF HEALTH AND HOSPITALS, OFFICE FOR CITIZENS WITH DEVELOPMENTAL DISABILITIES WAIVER SUPPORTS AND SERVICES IS ISSUING A NEW FORM FOR THE SUPPORTS WAIVER PROGRAM EFFECTIVE 3/27/07.THE JOB ASSESSMENT, JOB DISCOVERY, AND JOB DEVELOPMENT COMPLETION FORM IS TO BE USED FOR ALL REQUESTS FOR JOB ASSESSMENT, JOB DISCOVERY, AND JOB DEVELOPMENT. THE FORM IS AVAILABLE VIA THE WEBSITE WWW.LAMEDICAID.COM UNDER THE "NEW MEDICAID INFORMATION" LINK. PROVIDERS ARE ENCOURAGED TO VISIT THE OCDD WEBSITE AT HTTP://WWW.OCDD.DHH.LOUISIANA.GOV (CLICK ON
OCDD WAIVER UNIT LINK) FOR MORE INFORMATION.

ATTENTION ALL PROVIDERS

THE 2007 ANNUAL PROVIDER TRAINING WORKSHOPS WILL NOT BE HELD UNTIL LATE SUMMER AND EARLY FALL. PLEASE WATCH THE RA MESSAGES AND LAMEDICAID.COM WEBSITE FOR ANNOUNCEMENTS OF THESE WORKSHOPS. SINCE WORKSHOPS WILL NOT BE HELD IN THE SPRING, IT IS EXTREMELY IMPORTANT THAT YOU READ ALL RA MESSAGES AND VIEW THE WEB SITE REGULARLY FOR INFORMATION CONCERNING THE IMPLEMENTATION OF NATIONAL PROVIDER IDENTIFICATION NUMBERS (NPI) AND THE REVISED CLAIM FORMS CMS 1500 AND UB-04.

HOSPITAL PROVIDERS - BILLING OF UNLISTED PROCEDURE CODES

HOSPITALS ARE REMINDED WHEN BILLING FOR SERVICES WHICH REQUIRE THE USE OF AN UNLISTED PROCEDURE CODE (EXAMPLE: AMBULATORY SURGERY HR 490 WITH HCPC CODE 24999), THESE CLAIMS MUST BE SUBMITTED IN HARDCOPY FORM WITH SUPPORTING DOCUMENTATION. UNDERLINE IN THE DOCUMENTATION THE DESCRIPTION OF PERFORMED PROCEDURE.