PHARMACY PROVIDERS PLEASE NOTE!!!  

PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX C:                      

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.

IMPORTANT NOTICE TO UCC MEDICAID PROVIDERS

WE WILL BEGIN PAYING HURRICANE RITA CLAIMS THE WEEK OF JUNE 5. GET YOUR UCC RITA CLAIMS AS WELL AS YOUR KATRINA UCC CLAIMS SUBMITTED ASAP. JUNE 30 IS THE DEADLINE FOR ACCEPTING ALL UCC CLAIMS. WE WILL ALSO START PAYING THE BALANCE ON THE CLAIMS WITH A PATIENT PAID AMOUNT THE WEEK OF JUNE 5. IF YOU SUBMIT YOUR CLAIMS ON THE WEB, BE SURE TO SEND IN YOUR HARDCOPY OF THE ATTESTATION WITH A NOTE ATTACHED THAT YOUR CLAIMS WERE SUBMITTED ON THE WEB. NO CLAIMS WILL BE PROCESSED WITHOUT A COMPLETED ATTESTATION. CONTINUE TO MONITOR THE UCC WEBSITE FOR INFORMATION RELATED TO ADJUSTMENTS AND VOIDS OF UCC CLAIMS. 

CORRECTION/2006 TRAINING MANUAL 

THE FOLLOWING CORRECTION IS TO BE MADE ON PAGE 82 OF THE 2006 PROFESSIONAL SERVICES TRAINING MANUAL: 

THE WEBSITE ADDRESS FOR OBTAINING THE OMB NO. 0937-0166 FORM SHOULD BE: 
HTTP://OPA.OSOPHS.DHHS.GOV/PUBS/PUBLICATIONS.HTML 

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

REMINDER TO LT PCS PROVIDERS

THE LT-PCS PROGRAM PROHIBITS MEDICAID PAYMENTS TO A LEGALLY RESPONSIBLE RELATIVE AS THE RECIPIENT'S PERSONAL CARE SERVICE WORKER. LEGALLY RESPONSIBLE RELATIVE IS DEFINED AS THE RECIPIENT'S HUSBAND OR WIFE, LEGAL GUARDIAN, CURATOR OR TUTOR. A RELATIVE WHO IS NOT LEGALLY RESPONSIBLE COULD BE THE RECIPIENT'S LT-PCS WORKER IF HE/SHE MEETS THE QUALIFICATIONS TO BE A PCS WORKER AND IS HIRED BY A LICENSED, MEDICAID-ENROLLED LT-PCS AGENCY. THE MISSION OF MEDICAID FUNDED PERSONAL CARE SERVICES IS TO SUPPLEMENT THE FAMILY AND/OR COMMUNITY SUPPORTS THAT ARE AVAILABLE TO MAINTAIN THE RECIPIENT IN THE COMMUNITY. IT IS NOT A SUBSTITUTE FOR AVAILABLE FAMILY AND/OR COMMUNITY SUPPORTS. IN OTHER WORDS, IF THERE IS AN ADULT LIVING IN THE SAME HOME WHO IS NOT WORKING OR GOING TO SCHOOL, IS NOT DISABLED, AND IS CURRENTLY ACTING AS THE UNPAID, INFORMAL CAREGIVER, HE/SHE CANNOT BE PAID BY THE LT PCS PROGRAM. 

NATIONAL PROVIDER IDENTIFIER

DHH HAS LAUNCHED A NEW NPI WEB REGISTRATION SITE FOR PROVIDERS TO REGISTER THEIR NPI WITH LOUISIANA MEDICAID. CMS WILL REQUIRE ALL HIPAA STANDARD TRANSACTIONS, INCLUDING MEVS ELIGIBILITY INQUIRY AND CLAIMS STATUS INQUIRY TO BE SUBMITTED USING THE NPI NUMBER BEGINNING 23-MAY-07.THE NEW NPI APPLICATION IS ACCESSIBLE FROM THE LIST OF APPLICATIONS IN THE SECURED PROVIDER AREA OF THE WWW.LAMEDICAID.COM WEB SITE. FIND THIS AND MORE ON THE NPI INFORMATION PAGE ACCESSIBLE FROM WWW.LAMEDICAID.COM>HIPAA INFORMATION CENTER>NATIONAL PROVIDER IDENTIFIER (NPI).

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) WAS INCREASED BASED ON THE SERVICING PROVIDER. PROGRAMMING FOR THIS CHANGE HAS BEEN COMPLETED AND PROVIDERS MAY NOW SUBMIT CLAIMS. PROVIDERS MUST ENTER THE SERVICING PROVIDER'S (PSYCHIATRIST OR APRN ONLY) ACTIVE MEDICAID PROVIDER NUMBER IN ITEM 24K OF THE CMS 1500 CLAIM FORM. PROVIDERS FILING ELECTRONICALLY SHOULD CONTACT THEIR VENDOR IMMEDIATELY REGARDING ANY NECESSARY SOFTWARE UPDATES. 

NOTE: 90862 BILLING SHOULD NOT BE SPAN-DATED IF PERFORMED BY DIFFERENT PROVIDER TYPES DURING THAT PERIOD OF TIME. THE SEPARATE OCCURRENCES ON DIFFERENT DATES OF SERVICE FOR 90862 MUST BE BILLED SEPARATELY, WITH THE CORRECT PROVIDER NUMBER IN ITEM 24K. ONLY ONE OCCURRENCE OF MEDICATION MANAGEMENT MAY BE BILLED PER DAY PER RECIPIENT.

REVISED COMMUNITYCARE REFERRAL FORM

DHH HAS MADE ADDITIONAL REVISIONS/CORRECTIONS TO THE NEW COMMUNITYCARE REFERRAL FORM DATED MAY 2006. AN "EFFECTIVE DATE/DATE OF SERVICE" HAS BEEN ADDED TO SECTION 8 (POST ER AUTHORIZATION). THE REVISED FORM, WITH A REVISION DATE OF JUNE 2006, IS NOW AVAILABLE ON THE COMMUNITYCARE WEBSITE AT WWW.LA-COMMUNITYCARE.COM.