RA Messages for May 30, 2006

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 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 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. 

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.

ATTENTION EPSDT HEALTH SERVICES AND EARLYSTEPS PROVIDERS

DELETED CPT CODES 96100 (PSYCHOLOGICAL TESTING) AND 97504 (ORTHOTIC TRAINING) HAVE BEEN MADE NON-PAYABLE BY LOUISIANA MEDICAID EFFECTIVE JANUARY 1, 2006. PROCEDURE CODES 96101 (PSYCHOLOGICAL TESTING) AND 97760 (ORTHOTIC MANAGEMENT AND TRAINING) HAVE BEEN ADDED TO CPT FOR 2006 AND HAVE BEEN MADE PAYABLE ON OUR FILE EFFECTIVE JANUARY 1, 2006. 

ATTENTION PROVIDERS OF REHABILITATION THERAPY SERVICES

THE DEPARTMENT HAS BEEN MADE AWARE OF CLAIMS DENYING INAPPROPRIATELY FOR CERTAIN REHABILITATION PROCEDURE CODES. DENIED CLAIMS HAVE BEEN RECYCLED ON THE RA OF MAY 30, 2006. CLAIMS THAT ADJUDICATED (PAID) INAPPROPRIATELY WILL BE ADDRESSED IN THE NEAR FUTURE. FOR QUESTIONS OUTSIDE OF THESE SCENARIOS, CONTACT PROVIDER RELATIONS AT (800) 473-2783. 

ATTENTION UCC MEDICAID PROVIDERS

ALL INVOICES FOR UNCOMPENSATED CLAIMS MUST BE RECEIVED BY JUNE 30. DO NOT WAIT UNTIL THE LAST MINUTE IN CASE THERE IS SOMETHING INCORRECT THAT NEEDS TO BE CORRECTED. GO TO LAMEDICAID.COM, HURRICANE KATRINA LINK FOR ALL THE UPDATED INFORMATION ON UCC. IF YOU HAVE QUESTIONS REGARDING UCC, CALL DAWN GULCZYNSKI AT (225)216-6314 OR LAURIE TICHENOR AT (225) 216-6287. BE SURE TO SUBMIT THE NOTARIZED ATTESTATION WITH YOUR SUBMISSION. 

ATTENTION PROFESSIONAL SERVICES PROVIDERS
CORRECTION/2006 TRAINING MANUAL 

THE FOLLOWING CORRECTION IS TO BE MADE ON PAGE 20 OF THE 2006 PROFESSIONAL SERVICES TRAINING MANUAL: 

THE LAST SENTENCE UNDER THE HEADING OF 'PEDIATRIC MODERATE (CONSCIOUS) 
SEDATION' SHOULD READ: "NO CLAIMS WILL BE CONSIDERED FOR RECIPIENTS 
TWENTY-ONE YEARS OF AGE OR OLDER." 

IF YOU ATTENDED THE 2006 'PROFESSIONAL SERVICES' PROVIDER WORKSHOP, 
PLEASE MAKE THIS CORRECTION TO YOUR MANUAL.