RA Messages for March 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 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 COMMUNITYCARE PROVIDERS
EFFECTIVE 2-9-2006 COMMUNITYCARE PCPS
INTERESTED IN THE IMMUNIZATION PAY-FOR-PERFORMANCE(P4P) INITIATIVE CAN
BEGIN REGISTERING TO PARTICIPATE BY USING THE LOUISIANA MEDICAID WEBSITE
AT WWW.LAMEDICAID.COM. REGISTRATION FOR P4P CAN BE COMPLETED ONLY
THROUGH THIS WEBSITE. PROVIDERS ARE TO LOGIN USING THE ESTABLISHED LOGIN
PROCEDURES USING "PROVIDER LOGIN." ONCE LOGGED IN, FOLLOW THE
INSTRUCTIONS IN THE IMMUNIZATION PAY-FOR-PERFORMANCE (P4P) LINK. TO
QUALIFY FOR PARTICIPATION IN P4P RETROACTIVE TO JULY 1, 2006,
COMMUNITYCARE PCPS WILL HAVE THROUGH 3-11-2007 TO COMPLETE THE P4P
REGISTRATION PROCESS. PCPS THAT REGISTER AFTER 3-11-2007 WILL NOT BE
ELIGIBLE FOR RETROACTIVE PARTICIPATION BUT WILL BE ELIGIBLE TO
PARTICIPATE IN P4P STARTING WITH THE MONTH THEIR REGISTRATION IS
COMPLETED (EXCEPT PCPS WITH REGISTRATIONS FROM 3-12 TO
3-31-2007 WHO WILL BE ELIGIBLE FOR PARTICIPATION IN P4P STARTING
4-1-2007). DETAILS, INCLUDING CONTACT INFORMATION, CAN BE FOUND AT THE
P4P LINK MENTIONED ABOVE.
ATTENTION DENTAL PROVIDERS
EFFECTIVE 4/2/07, THE 2006 ADA CLAIM
FORM WILL BE REQUIRED WHEN SUBMITTING HARDCOPY DENTAL CLAIMS TO MEDICAID
FOR PAYMENT AND PRIOR AUTHORIZATION. REFER TO WWW.LAMEDICAID.COM UNDER
"NEW MEDICAID INFORMATION" FOR ADDITIONAL DETAILS.
ATTENTION COMMUNITYCARE PROVIDERS
WITH CHANGES TO PROVIDER NUMBERS
IMMUNIZATION PAY-FOR-PERFORMANCE
COMMUNITYCARE PCPS WHO HAVE HAD A
CHANGE IN THEIR MEDICAID PROVIDER # DUE TO A CHANGE IN THEIR PROVIDER
TYPE (INDIVIDUAL NUMBER TO GROUP, GROUP NUMBER TO RHC, ETC.) THAT WAS
EFFECTIVE 7/1/2006 OR AFTER AND ARE INTERESTED IN PARTICIPATING IN THE
IMMUNIZATION PAY-FOR-PERFORMANCE (P4P) INITIATIVE SHOULD NOTE THE
FOLLOWING IMPORTANT INSTRUCTIONS:
TO ENSURE ACCURATE IDENTIFICATION OF
APPROPRIATE IMMUNIZATION RECORDS, THE P4P REGISTRATION PROCESS MUST BE
COMPLETED FOR EACH COMMUNITYCARE PCP PROVIDER NUMBER (PREVIOUS AND
CURRENT) THAT HAD LINKAGES FOR RECIPIENTS UNDER THE AGE OF 21 YEARS OLD.
TO BE ELIGIBLE FOR PARTICIPATION IN
P4P RETROACTIVE TO 7/1/2006, THE REGISTRATION PROCESS MUST BE COMPLETED
BY 3/11/2007.THE P4P REGISTRATION MUST BE COMPLETED ON THE
WWW.LAMEDICAID.COM SECURED WEBSITE.
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
EFFECTIVE 2/9/2007, THE DEPARTMENT OF
HEALTH AND HOSPITALS HAS IMPLEMENTED THE $2.00 WAGE PASS-THROUGH FOR
DIRECT CARE WORKERS IN SPECIFIC LONG TERM CARE SERVICES, INCLUDING
NURSING FACILITIES, ICF/DD, LT-PCS AND CERTAIN HOME AND COMMUNITY-BASED
WAIVERS. ADDITIONAL INFORMATION ON IMPLEMENTING THE INCREASE, AS WELL AS
THE REQUIRED FORMS AND INSTRUCTIONS FOR REPORTING MAY BE FOUND ON THE
WEB AT WWW.LAMEDICAID.COM
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.