RA Messages for May 25, 2004

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.

ON THE TAPE OF 3/8/04, FIRST DATABANK CHANGED THE SIZE AND UNITS OF RISPERDAL, (50458-0306-11, -0307-11 AND -0308-11) FROM 2(ML) TO 1(UNIT) BUT THEY DID NOT CHANGE THE PRICE UNTIL THE FOLLOWING WEEK. SO, FOR ONE WEEK CLAIMS FOR THESE NDCS COULD HAVE PAID INCORRECTLY. PLEASE SUBMIT ADJUSTMENTS IF NECESSARY.     

PLEASE MAKE THE FOLLOWING CHANGES TO THE 5/01/04 VERSION OF APPENDIX C:

LABELER COMPANY   BEGIN END 
00058 NOVARTIS PHARMACEUTICALS CORPORATION     07/01/04
00369 SCHERING CORPORATION    07/01/04
00372  SCOT-TUSSIN PHARMACAL COMPANY, INC.    07/01/04
00514 BERTEK PHARMACEUTICALS, INC.    07/01/04
52316  DSC LABORATORIES DIV DSC PRODUCTS, INC.    07/01/04
53706 DELTA PHARMACEUTICALS, INC.   04/01/04   
53807 RIJ PHARMACEUTICAL CORPORATION      07/01/04
57267 NOVARTIS PHARMACEUTICALS CORPORATION    07/01/04
57459 NASTECH PHARMACEUTICAL COMPANY      07/01/04
58887   NOVARTIS PHARMACEUTICALS CORPORATION    07/01/04
60242 NEIL LABORATORIES, INC   07/01/04     
61113  ASTRA ZENECA PHARMACEUTICALS        07/01/04
61392  HEARTLAND SERVICES       07/01/04
61953 GRIFOLS BIOLOGICALS, INC. 07/01/04   
63955   GYNETICS    07/01/04
64248  WOMEN'S FIRST HEALTH CARE    07/01/04
67618 PURDUE PRODUCTS, L.P.  07/01/04    
67857 REDDY PHARMACEUTICALS        07/01/04  
68180 LUPIN PHARMACEUTICALS, INC   07/01/04    
68669  VISTAKON PHARMACUTICALS LLC   07/01/04    

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

NOTICE TO PROVIDER OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2003.  THE FOLLOWING CPT CODES WILL BE ADDED TO THE LIST OF CODES PAYABLE TO AUDIOLOGISTS.

92541 92543 92544 92545 92547

ATTENTION RHC/FQHC PROVIDERS

EFFECTIVE WITH DATE OF SERVICE MAY 10, 2004 AND AFTER, MENTAL HEALTH SERVICES PROVIDED BY A PSYCHIATRIST EMPLOYED BY A RURAL HEALTH CLINIC OR FEDERALLY QUALIFIED HEALTH CENTER WILL NOT REQUIRE A COMMUNITYCARE PCP REFERRAL AND WILL BE EXCLUDED FROM THE COMMUNITYCARE 106 EDIT. THE PSYCHIATRIST MUST BE ENROLLED AND HAVE AN INDIVIDUAL LA MEDICAID PROVIDER NUMBER. RHC/FQHC PROVIDERS MUST ENTER THIS INDIVIDUAL PSYCHIATRIST'S 7-DIGIT MEDICAID PROVIDER NUMBER IN BLOCK 24K OF THE CMS-1500 CLAIM FORM (OR THE EQUIVALENT FIELD IF BILLING ELECTRONICALLY). THIS WILL ALLOW THE CLAIM TO PROCESS PROPERLY.THIS EHC/FQHC EXCLUSION APPLIES ONLY TO MENTAL HEALTH SERVICES PROVIDED BY A PSYCHIATRIST. 

ATTENTION OPTHAMOLOGISTS AND OPTOMETRISTS

OPTHAMOLOGISTS AND OPTOMETRISTS THAT HAVE RECEIVED A 690 DENIAL (PAYMENT INCLUDED IN SURGERY FEE) WHEN BILLING PROCEDURE CODE 99211 (FOLLOW-UP EXAM) ON THE SAME DATE OF SERVICE AS THE INITIAL EYE EXAM AND GLASSES SHOULD REBILL PROCEDURE CODE 99211. A ONE DAY GLOBAL SURGERY PERIOD WAS INADVERTENTLY ADDED TO THE INITIAL EYE EXAM PROCEDURE CODE, CAUSING THESE DENIALS.

ATTENTION PHARMACY PROVIDERS

2004 ANNUAL PHARMACY PROVIDER TRAINING WORKSHOPS ARE SCHEDULED FOR THE 
FOLLOWING DATES AND LOCATIONS. PLEASE MAKE YOUR PLANS TO ATTEND ONE OF 
THESE IMPORTANT SESSIONS: 

DATE CITY  LOCATION TIME 
JUNE 8, 2004 BATON ROUGE  BATON ROUGE GENERAL HOSPITAL 7-9 A.M.
JUNE 8, 2004  NEW ORLEANS BEST WESTERN LANDMARK HOTEL 5-7 P.M.
JUNE 9, 2004 LAFAYETTE OUR LADY OF LOURDES HOSPITAL 7-9 A.M.
JUNE 9, 2004  SHREVEPORT WILLIS KNIGHTON 5-7 P.M.
JUNE 10, 2004 MONROE UNIVERSITY OF LOUISIANA MONROE 7-9 A.M.

ATTENTION ALL PROVIDERS

THE LA MEDICAID CLAIMS STATUS INQUIRY APPLICATION (E-CSI) IS NOW IN PRODUCTION. THIS NEW APPLICATION IS HIPAA COMPLIANT; ALLOWS PROVIDERS TO OBTAIN THE STATUS OF CLAIMS SUBMITTED TO LA MEDICAID; AND CAN BE FOUND IN THE SECURE AREA OF THE LA MEDICAID WEBSITE, LAMEDICAID.COM. ONLY CLAIMS WITH A FINAL DISPOSITION WILL BE ACCESSIBLE FROM THE APPLICATION, I.E. PAID, DENIED, VOIDED, ETC. PROVIDERS WILL NOT BE ABLE TO VIEW PENDED CLAIMS. TO ENSURE APPROPRIATE SECURITY OF THE RECIPIENT/PROVIDER INFORMATION, PROVIDERS WHO DO NOT CURRENTLY HAVE A LOGIN AND PASSWORD FOR THIS AREA OF THE WEBSITE MUST OBTAIN ONE IN ORDER TO ACCESS THE APPLICATION. A LOGIN AND PASSWORD MAY BE OBTAINED BY USING THE LINK, PROVIDER WEB ACCOUNT REGISTRATION INSTRUCTIONS. EFFECTIVE IMMEDIATELY, PROVIDERS WISHING TO CHECK THE STATUS OF CLAIMS SUBMITTED TO LA MEDICAID SHOULD USE THIS APPLICATION. A DETAILED USER GUIDE ON HOW TO USE THE APPLICATION CAN BE OBTAINED BY SELECTING THE HELP BUTTON FROM WITHIN THE APPLICATION. SHOULD YOU NEED ASSISTANCE WITH OBTAINING A LOGIN AND PASS WORD OR HAVE QUESTIONS ABOUT THE TECHNICAL USE OF THE APPLICATION, PLEASE CONTACT THE UNISYS TECHNICAL SUPPORT DESK AT 877-598-8753.