RA Messages for March 29, 2005

PHARMACY PROVIDERS, PLEASE NOTE!!!
ERECTILE DYSFUNCTION MEDICATIONS

EFFECTIVE WITH DATE OF SERVICE OF MARCH 20, 1--5, ONLY ONE (1) UNIT OF ANY ERECTILE DYSFUNCTION MEDICATION PER RECIPIENT PER CALENDAR MONTH WILL BE REIMBURSED BY MEDICAID.  CLAIMS EXCEEDING THIS QUANTITY WILL DENY WITH ERROR CODE 457 (QUANTITY OVER PROGRAM MAX) WHICH IS LINKED TO NCPDP CODE 76 (PLAN LIMITATION EXCEEDED).

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 WHICH MAY HAVE BEEN INCORRECTLY PAID

ATTENTION ANESTHESIA PROVIDERS

EFFECTIVE 3/1/05. THE HARD COPY MANDATE FOR THE FOLLOWING ANESTHESIA CODES HAS BEEN LIFTED FOR DATES OF SERVICE 10/01/03 AND FORWARD. 

00300 00402 00404 00406 00410 00620 00630 00790 00792  00794
00800 00810 00820  00840 00872 00873 00918 00920  00940 00942 

ATTENTION ALL MENTAL HEALTH REHAB PROVIDERS

PLEASE NOTE THE FOLLOWING AS PUBLISHED IN THE CURRENT MENTAL HEALTH REHAB MANUAL, SECTION 5-1-B-1, DATED JULY 1, 1999 REGARDING APPROVAL OF ASSESSMENT, WHICH STATES: 

"THE ASSESSMENT MUST BE COMPLETED WITHIN 30 DAYS OF APPROVAL. EXTENSIONS
MUST BE APPROVED BY THE PA UNIT." 

IF THERE ARE EXTENUATING CIRCUMSTANCES, THE MHR PROVIDER SHOULD THOROUGHLY DOCUMENT THE REASON FOR THE REQUEST FOR EXTENSION. THE PA STAFF WILL THEN DETERMINE IF THE EXTENSION IS WARRANTED ON A CASE BY CASE BASIS. 

IF YOU HAVE ANY FURTHER QUESTIONS, CONTACT DAWN R. MATTE, PROGRAM 
COORDINATOR, AT 225-342-1247.

ATTENTION SUBMITTERS OF ELECTRONIC CLAIMS

BEGINNING 1-1-2005, ALL CLAIMS SUBMITTED TO LOUISIANA MEDICAID VIA ELECTRONIC SUBMISSION WILL REQUIRE ONE ANNUAL CERTIFICATION FORM PER SUBMITTER NUMBER. THIS CERTIFICATION FORM WILL BE RENEWED DURING THE 4Q OF EACH YEAR FOLLOWING THE INITIAL TRANSITION. CORRESPONDENCE WILL BE MAILED TO EACH OPEN SUBMITTER OF FILE IN EARLY APRIL. THE FIRST DEADLINE FOR RECEIPT OF COMPLETED ANNUAL CERTIFICATION FORMS IS MAY 15, 2005. 

ATTENTION KIDMED AND PREVENTIVE MEDICINE PROVIDERS

A DHH EMERGENCY RULE REQUIRES ALL MEDICAID PROVIDERS SUBMITTING KIDMED/ PREVENTIVE MEDICINE CLAIMS TO SUBMIT DETAIL CLAIM DATA INCLUDING THE ACTUAL SCREENING AND IMMUNIZATION STATUS; SUSPECTED CONDITIONS; AND REFERRAL INFORMATION RELATED TO SUSPECTED CONDITIONS. THIS REQUIREMENT APPLIES TO BOTH ELECTRONIC AND PAPER CLAIMS. ELECTRONIC 837P KIDMED TRANSACTIONS MUST INCLUDE THE K3 SEGMENT, AND THE "FILE EXTENSION" MUST BE KID, NOT PHY. PROVIDERS BILLING PAPER CLAIMS USING THE CMS 1500 CLAIM FORM WITH ONLY THE SCREENING CODES MUST NOW SUBMIT THE KM-3 CLAIM FORM WITH ALL DETAIL INFORMATION. EDUCATIONAL EDITS (517 AND 518 OR HIPAA ADJUSTMENT REASON CODE 16 FOR 835 ELECTRONIC RA) CURRENTLY APPEAR ON ANY ELECTRONIC AND HARD COPY CLAIMS PAYMENTS IF ALL APPLICABLE KIDMED CLAIM DETAIL IS NOT PROVIDED. EFFECTIVE APRIL 1, 2005, EDITS 517(KIDMED FORMAT REQUIRED - CLAIM MUST BE SUBMITTED ON KIDMED FORMAT), 518(KIDMED INFORMATION MISSING - IMMUNIZATION AND SUSPECTED CONDITION INFORMATION REQUIRED) AND HIPAA REASON CODE 16 WILL DENY CLAIMS THAT ARE SUBMITTED ON THE 837P OR THE CMS 1500 CLAIM FORM WITHOUT KIDMED DETAIL.