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. 

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

OUTPATIENT HOSPITAL MEDICARE CROSSOVER CLAIMS

THE DEPARTMENT HAS IDENTIFIED A CLAIMS PROCESSING PROBLEM INVOLVING HARD COPY OUTPATIENT HOSPITAL MEDICARE CROSSOVER CLAIMS WHEN HR001 IS REPORTED. EFFECTIVE RA DATE 4/25/2006, THIS LOGIC HAS BEEN CORRECTED. NO ACTION IS REQUIRED OF MEDICAID PROVIDERS. ANY QUESTIONS SHOULD BE DIRECTED TO PROVIDER RELATIONS. 

ATTENTION DENTAL PROVIDERS

AS A RESULT OF THE MEDICAID BUDGET CUT RESTORATION, MEDICAID AUTOMATICALLY ADJUSTED DENTAL CLAIMS ON THE RA DATED 4/11/06 IN ORDER TO PAY DENTAL PROVIDERS THE DIFFERENCE BETWEEN THE REDUCED FEE AND THE REGULAR MEDICAID RATE FOR DATES OF SERVICE 1/1/06 THROUGH 2/16/06. A SMALL NUMBER OF THESE CLAIMS (70) ADJUSTED TO $0 INSTEAD OF PAYING THE DIFFERENCE BETWEEN THE REDUCED AMOUNT AND THE REGULAR MEDICAID RATE. THE $0 ADJUSTMENT CAUSED THE INITIAL PAYMENT FOR THAT CLAIM TO BE SUBTRACTED FROM THE PROVIDER'S PAYMENT FOR THAT WEEK. IN ORDER TO CORRECT THESE PAYMENTS, ANOTHER DENTAL CLAIM ADJUSTMENT APPEARS ON THE RA DATED 4/25/06. IF YOU HAVE ANY QUESTIONS, YOU MAY CALL THE DENTAL MEDICAID UNIT AT (225) 216-6470. 

2006 PROVIDER TRAINING WORKSHOPS

THE 2006 ANNUAL PROVIDER TRAINING WORKSHOPS WILL BEGIN ON APRIL 24, 2006 AND RUN THROUGH MAY 24, 2006. THE DETAILED TRAINING SCHEDULE IS AVAILABLE ON THE LA MEDICAID WEBSITE, WWW.LAMEDICAID.COM AND IN THE UPCOMING PROVIDER NEWSLETTER. PLEASE ACCESS THESE SOURCES FOR DETAILS. 

BATON ROUGE    APRIL 24-26, 2006                MONROE           MAY 11-12, 2006 
HOUMA                 MAY 1-3, 2006                      ALEXANDRIA   MAY 16-18, 2006 
LAKE CHARLES   MAY 4-5, 2006                      LAFAYETTE MAY 22-24, 2006 
SHREVEPORT       MAY 8-10, 2006