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 MENTAL HEALTH REHABILITATION PROVIDERS

EFFECTIVE WITH DATES OF SERVICE MAY 1, 2006 THE REIMBURSEMENT RATE FOR ASSESSMENT (PROCEDURE CODE H0031) IS BEING INCREASED TO $206.08. PROVIDERS SHOULD BEGIN BILLING THE INCREASED RATE FOR DATES OF SERVICE MAY 1, 2006 OR LATER.

ATTENTION MENTAL HEALTH REHABILITATION PROVIDERS

EFFECTIVE WITH DATES OF SERVICE JUNE 1, 2006 THE REIMBURSEMENT RATE FOR MEDICATION ASSESSMENT, MONITORING AND EDUCATION (PROCEDURE CODE 90862) IS BEING INCREASED. THE MAXIMUM ALLOWABLE FEE FOR THIS PROCEDURE WILL BE $49.64 WHEN THE SERVICING PROVIDER IS A PSYCHIATRIST, $39.71 WHEN THE SERVICING PROVIDER IS AN APRN AND $33.26 WHEN THE SERVICING PROVIDER IS A RN. PROVIDERS MUST ENTER THE SERVICING PROVIDER'S (PSYCHIATRIST OR APRN ONLY) INDIVIDUAL MEDICAID PROVIDER NUMBER IN ITEM 24 K OF THE CMS 1500 CLAIM FORM. IF ITEM 24 K IS BLANK, PAYMENT WILL BE MADE AT THE RN RATE. 

ATTENTION PHARMACY PROVIDERS

UPDATES TO THE PHARMACY BENEFITS MANAGEMENT SERVICES MANUAL ARE NOW AVAILABLE ON THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM. POLICY HAS BEEN UPDATED IN SECTIONS 37.5 - COVERED SERVICES, LIMITATIONS AND EXCLUSIONS; 37.6 - REIMBURSEMENT FOR SERVICES; AND 37.7 - MEDICARE PRESCRIPTION DRUG COVERAGE. PHARMACY PROVIDERS SHOULD REFER TO THE MANUAL FOR A COMPLETE DESCRIPTION OF MEDICAID PHARMACY PROGRAM POLICY. 

ATTENTION NEW OPPORTUNITY WAIVER SERVICES PROVIDERS

DUE TO INFORMATION FROM CMS, BEGINNING JUNE 15, 2006, PROVIDERS OF MEDICAID NEW OPPORTUNITY WAIVER SERVICES WILL NO LONGER BE REIMBURSED FOR PROVIDING WAIVER SERVICES TO PARTICIPANTS DURING INPATIENT HOSPITAL DAYS. SEE DHH WEBSITE FOR FURTHER INFORMATION.

HOSPITAL PRECERTIFICATION
MD TO MD CONFERENCES 

THE FOLLOWING IS THE DEPARTMENT OF HEALTH AND HOSPITALS POLICY AND INSTRUCTIONS REGARDING HOSPITALS THAT MISS MD TO MD CONFERENCES: 

• ALL MD TO MD CONFERENCES MUST BE SCHEDULED AND COMPLETED WITHIN 6 
  MONTHS OF THE DATE OF THE FIRST PRECERT DENIAL. 

• IF A HOSPITAL MISSES AN MD TO MD CONFERENCE THE HOSPITAL WOULD FORFEIT
  THE RIGHT TO FURTHER MD TO MD CONFERENCES AND WOULD HAVE TO GO THROUGH
  THE APPEAL PROCESS FOR FURTHER RELIEF. 

• IF A HOSPITAL MISSED AN MD TO MD CONFERENCE BECAUSE OF EXTENUATING 
  CIRCUMSTANCES AND HAS LESS THAN TWO (2) MISSED MD TO MD REVIEWS, 
  UNISYS WILL RESCHEDULE A CONFERENCE.

ANY QUESTIONS REGARDING THE ABOVE POLICY AND PROCEDURES SHOULD BE 
DIRECTED TO SANDY WHITCOMB, OR JANEEN TARROW IN THE UNISYS HOSPITAL 
PRECERTIFICATION DEPARTMENT AT 1-800-877-0666.