PHARMACY PROVIDERS PLEASE NOTE!!!

DETAILED FUL CHANGES ARE POSTED ON WWW.LAMEDICAID.COM.

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 PROVIDERS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES

IN CASES IN WHICH THE RECIPIENT HAS PRIVATE INSURANCE, ALL PA REQUESTS FOR DURABLE MEDICAL EQUIPMENT AND SUPPLIES SHALL INCLUDE A COPY OF THE EXPLANATION OF MEDICAL BENEFITS (EOMB) FROM THE PRIVATE INSURANCE COMPANY. 

ATTENTION DENTAL PROVIDERS

EFFECTIVE 2/17/06, THE DENTAL REIMBURSEMENT RATES THAT WERE REDUCED DUE TO A BUDGET CUT WERE RESTORED RETROACTIVE TO 1/1/06. ALL DENTAL CLAIMS FOR DATES OF SERVICE 1/1/06 - 2/16/06, THAT WERE BILLED AT HIGHER THAN THE REDUCED MEDICAID RATE, WILL BE AUTOMATICALLY ADJUSTED BY MEDICAID. THE ADJUSTED CLAIMS WILL APPEAR ON THE RA DATED 4/11/06. PROVIDERS WILL BE RESPONSIBLE FOR CLAIM CORRECTIONS IF THEY BILLED AT THE REDUCED MEDICAID RATES INSTEAD OF THEIR USUAL AND CUSTOMARY FEE, AS REQUIRED BY MEDICAID. IF THERE ARE ANY PROVIDERS WHO BILLED AT THE REDUCED MEDICAID RATES RATHER THAN THEIR USUAL AND CUSTOMARY FEES, AND A CLAIM CORRECTION IS NECESSARY, THE PROVIDER MUST CONTACT THE DENTAL MEDICAID UNIT AT 225-216-6470 FOR FURTHER INSTRUCTIONS PRIOR TO REFILING THE CLAIM. 

ATTENTION PHYSICIANS, DME, AND PHARMACY PROVIDERS

THIS IS TO ADVISE THAT DISPOSABLE INCONTINENCE PRODUCTS (DIAPERS, PULL- UPS, LINERS, AND GUARDS) ARE COVERED FOR ELIGIBLES AGE 4 THROUGH 20 YEARS OF AGE BASED ON MEDICAL NECESSITY CRITERIA IN THE DME PROGRAM. CRITERIA TO ESTABLISH MEDICAL NECESSITY IS AVAILABLE VIA THE WEBSITE WWW.LAMEDICAID.COM UNDER THE "NEW MEDICAID INFORMATION" LINK. IF YOU HAVE ANY QUESTIONS, YOU MAY CONTACT UNISYS PROVIDER RELATIONS AT 1-800-473-2783.

ATTENTION OUT OF STATE PROVIDERS 
INPATIENT ACUTE CARE AND PSYCHIATRIC SERVICES 

WE ARE EXPERIENCING SEVERAL PROGRAMMING PROBLEMS WITH CLAIMS RECEIVED FROM OUT-OF-STATE PROVIDERS FOR EMERGENCY CLAIMS, PSYCHIATRIC INPATIENT STAYS AND OUTPATIENT CLAIMS. 

CLAIMS BILLED FOR INPATIENT PSYCHIATRIC STAYS THAT RECEIVED DENIALS OF EITHER A '117' OR '118', WHICH HAD DATES OF SERVICE AUGUST 24, 2005 - DECEMBER 31, 2005 AND WERE FOR RECIPIENTS ASSOCIATED WITH HURRICANE KATRINA, WERE REPROCESSED ON APRIL 4, 2006. ORIGINALLY CLAIMS FOR THE ENTIRE STAY OF MORE THAN 2 DAYS WERE DENIED. RESUBMITTED CLAIMS FOR A MAXIMUM OF 2 DAYS WERE REIMBURSED FOR ONLY THE 2 DAYS. PROVIDERS WHICH RECEIVED PAYMENT FOR LESS THAN THE ENTIRE STAY MAY SUBMIT A VOID FOR THE PAID CLAIM USING A UB92 WITH A '118' IN FIELD 4 AND THE ICN NUMBER OF THE PAID CLAIM IN FIELD 84. ONCE THE VOID IS PROCESSED, THE PROVIDER MAY
THEN SUBMIT A NEW CLAIM FOR THE ENTIRE STAY. 

OUT-OF-STATE PROVIDERS WHICH HAVE BILLED FOR EITHER OUTPATIENT EMERGENCY SERVICES OR EMERGENCY SERVICES WHICH RESULTED IN AN INPATIENT STAY MAY BE RECEIVING INAPPROPRIATE '532' DENIALS. WE ARE CURRENTLY WORKING TO RESOLVE THIS PROGRAMMING PROBLEM. FURTHER INFORMATION WILL BE FORTHCOMING ONCE THIS ISSUE IS RESOLVED. 

HOSPITAL OUTPATIENT AMBULATORY SURGERY FEE SCHEDULE

EFFECTIVE APRIL 1, 2006, THE HOSPITAL OUTPATIENT AMBULATORY SURGERY LIST HAS BEEN PLACED AS A FEE SCHEDULE ON THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM . TO VIEW, CLICK ON FEE SCHEDULES TO THE LEFT OF THE SCREEN AND THEN ON HOSPITAL OUTPATIENT AMBULATORY SURGERY FEE SCHEDULE. THIS FEE SCHEDULE WILL BE REFRESHED AT THE BEGINNING OF EVERY MONTH. 

AMBULATORY SURGICAL CENTER BILLING

LOUISIANA MEDICAID IDENTIFIED A PROBLEM WHERE FACILITY FEES FOR AMBULATORY SURGICAL CENTERS WERE BEING REIMBURSED AT THE FEE RATE FOR PHYSICIAN SERVICES OR NOT ASSIGNED TO A SURGICAL GROUPING. PROGRAMMING IS BEING UPDATED TO ASSIGN EACH PROCEDURE TO A GROUPING WHICH MAY RESULT IN REIMBURSEMENT CHANGES.

ATTENTION ALL MEDICAID PROVIDERS

MANY PROVIDERS PROVIDED HEALTH CARE SERVICES TO KATRINA AND RITA EVACUEES AND AFFECTED INDIVIDUALS WHO DID NOT HAVE HEALTH COVERAGE THROUGH INSURANCE OR ANY OTHER FINANCING MECHANISM. FEDERAL FUNDS ARE NOW AVAILABLE THROUGH THE UNCOMPENSATED CARE COST POOL PLAN TO PAY FOR THESE SERVICES IF THE PROVIDER AND EVACUEE OR AFFECTED INDIVIDUAL MEET THE PLAN CRITERIA. GO TO THE LAMEDICAID WEBSITE HTTP://WWW.LAMEDICAID.COM/PROVWEB1/HURRICANERELIEFPOOLPLAN.HTM TO FIND THE CRITERIA AND THE INFORMATION NEEDED FOR INVOICE SUBMISSION. 

ATTENTION LOUISIANA HURRICANE RELIEF

UNCOMPENSATED CARE POOL PROVIDERS SEE THE MEMO REGARDING PATIENT PARTIAL PAYMENT CLAIMS ON THE LAMEDICAID.COM WEBSITE. GO TO HTTP://WWW.LAMEDICAID.COM/PROVWEB1/HURRICANERELIEFPOOLPLAN.HTM