RA Messages for May 14, 2002

 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 MAKE THE FOLLOWING CHANGES TO THE 1/1/02 VERSION OF APPENDIX C:

LABELER               COMPANY BEGIN END
00535 GILBERT LABORATORIES 07/01/02  
10337 DOAK DERMATOLOGICS 07/01/02  
11086 SUMMERS LABORATORIES    07/01/02
63004 QUESTOR PHARMACEUTICALS 07/01/02  
66239  SCIENTIFIC LABORATORIES, INC 07/01/02  
66424  SDA LABORATORIES 07/01/02               
66479 XANODYNE PHARMACAL, INC 07/01/02  
66490 XCEL PHARMACEUTICALS,INC 07/01/02  

 PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

NOTICE TO ALL PROVIDERS

THE CONTRACT "PROVIDER'S ELECTION TO EMPLOY ELECTRONIC MEDIA SUBMISSION OF CLAIMS FOR PROCESSING IN THE LOUISIANA MEDICAL ASSISTANCE PROGRAM" WAS REVISED IN AUGUST 2001. EFFECTIVE JUNE 3, 2002, PROVIDER ENROLLMENT WILL NO LONGER ACCEPT ANY VERSION OF THIS CONTRACT WITH A REVISION DATE PRIOR TO AUGUST 2001. ALL REQUESTS SUBMITTED ON OUTDATED CONTRACTS WILL BE RETURNED TO YOU WITH THE CORRECT FORMS FOR RESUBMISSION. IF YOU NEED TO OBTAIN AN UPDATED COPY, PLEASE CALL THE EMC DEPARTMENT AT (225) 237- 3200, EXT. 2. 

PHYSICIANS AND HOSPITALS, INPATIENT AND OUTPATIENT, AND ANESTHESIA PROVIDERS

UNISYS PROVIDER RELATIONS HAS RECEIVED QUESTIONS CONCERNING THE DENIAL 478 (SEND WRITTEN SONOGRAM RESULTS WITH OPERATIVE REPORT, PATHOLOGY REPORT AND HISTORY.) WHEN A D&C IS DONE FOR AN INCOMPLETE OR MISSED ABORTION AND ERROR 478 IS RECEIVED, THE REVIEW TEAM MUST HAVE DOCUMENTATION TO SUBSTANTIATE THAT THE FETUS WAS NOT LIVING AT THE TIME OF THE D&C; THAT IS, THAT THIS WAS NOT AN ABORTION FOR PREGNANCY TERMINATION. THIS DOCUMENTATION MAY BE (1)A SONOGRAM REPORT SHOWING NO FETAL HEART TONES; (2) A HISTORY SHOWING PASSAGE OF FETUS AT HOME, IN AN AMBULANCE, OR IN THE EMERGENCY ROOM; (3) A PATHOLOGY REPORT SHOWING DEGENERATING PRODUCTS OF CONCEPTION; OR (4) AN OPERATIVE REPORT SHOWING PRODUCTS OF CONCEPTION IN THE VAGINA.  ALL REPORTS ARE NOT NEEDED.  THESE ARE EXAMPLES OF THE INFORMATION NEEDED TO PROVIDE ENOUGH DOCUMENTATION TO PROPERLY REVIEW THE CLAIM AND SUBSTANTIATE PAYMENT.