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. 

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.

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. 

IMPORTANT UPDATE TO PROVIDER NOTICE ISSUED FEBRUARY 28, 2006:

ATTENTION WAIVER SERVICE PROVIDERS, SERVICE PROVIDERS FOR 
LT-PCS AND EPSDT SERVICES AND SUPPORT COORDINATORS

POLICY/PROCEDURES CHANGES ISSUED SEPTEMBER 9, 2005 IN RESPONSE TO 
HURRICANE KATRINA EXPIRED FEBRUARY 28, 2006. THREE OF THE CHANGES HAVE 
BEEN EXTENDED, SUBJECT TO CERTAIN REQUIREMENTS, FOR PROVIDERS STILL 
AFFECTED BY KATRINA, PLEASE REFER TO 
HTTP://WWW.LAMEDICAID.COM/PROVWEB1/KATRINA/WAIVERSERVICES.PDF  FOR POLICY
AND PROCEDURE CLARIFICATION. 

ATTENTION WAIVER SERVICE PROVIDERS AND SUPPORT COORDINATORS

EFFECTIVE JULY 1, 2006, THE DEPARTMENT OF HEALTH AND HOSPITALS (DHH) WILL HAVE TWO CHANGES IN THE EDA WAIVER SERVICE PACKAGE: 1) REMOVAL OF HOUSEHOLD SUPPORTS; AND 2) PERSONAL SUPERVISION (DAY) AND PERSONAL SUPERVISION (NIGHT) WILL BE COMBINED TO ONE SERVICE KNOWN AS COMPANION SERVICE. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT YOUR DIVISION OF LONG TERM SUPPORTS AND SERVICES (DLTSS) REGIONAL OFFICE STAFF AND/OR SUPPORT COORDINATION AGENCIES. PLEASE REFER TO THE FOLLOWING WEBSITE: HTTP://WWW.LAMEDICAID.COM . 

ATTENTION PROFESSIONAL SERVICES PROVIDERS

THE 2006 HCPCS CODES HAVE BEEN LOADED TO OUR FILES AND MAY BE SUBMITTED FOR DATES OF SERVICE JANUARY 1, 2006 FORWARD. LOOK IN THE UPDATED 2006 FEE SCHEDULE ON THE LOUISIANA MEDICAID WEBSITE, WWW.LAMEDICAID.COM IN THE NEAR FUTURE.