RA Messages for June 26, 2001

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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.

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PLEASE MAKE THE FOLLOWING CHANGES TO THE 12/9/00 VERSION OF APPENDIX A:

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PLEASE MAKE THE FOLLOWING CHANGES TO THE 12/9/00 VERSION OF APPENDIX C:   

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

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NOTICE TO DENTAL PROVIDERS

CLARIFICATION OF ADULT DENTURE PROGRAM - PARTIAL DENTURE POLICY THIS NOTICE IS TO PROVIDE CLARIFICATION OF EXISTING ADULT DENTURE PROGRAM -PARTIAL DENTURE POLICY WHICH CAN BE FOUND ON PAGES 5-12 AND 5-13 OF THE MEDICAID DENTAL SERVICES MANUAL.  REMOVABLE ACRYLIC PARTIAL DENTURES WILL ONLY BE PROVIDED AS A PROGRAM BENEFIT IN THE FOLLOWING SELECT INSTANCES:1)THE PARTIAL DENTURE MUST  OPPOSE A FULL DENTURE; AND 2)THE RECIPIENT MUST BE MISSING AT LEAST TWO  ANTERIOR TEETH, OR MISSING AT LEAST FOUR POSTERIOR TEETH ON EITHER SIDE  OF THE ARCH FOR WHICH THE PARTIAL DENTURE IS REQUESTED; AND 3)THE POTENTIAL ABUTMENT TEETH SHOULD BE CARIES FREE OR PROPERLY RESTORED,  PERIODONTIALLY SOUND TO LAST FOR SEVEN YEARS. ON PARTIAL DENTURE AND ONE RELINE PER ARCH ARE ALLOWED IN A SEVEN-YEAR  PERIOD. THE DELIVERY OF A PARTIAL DENTURE PREVENTS AN AUTHORIZATION OF A COMPLETE DENTURE FOR THAT ARCH FOR SEVEN YEARS. THE PROGRAM DOES NOT  PROVIDE OR FUND TWO PARTIALS IN THE SAME ORAL CAVITY. SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS POLICY, YOU MAY CONTACT THE LSU SCHOOL OF DENTISTRY BY CALLING 504-619-8589. 

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

THE CPT CODES WHICH WERE DISCONTINUED IN THE YEAR 2001 ISSUANCE OF THE  CURRENT PROCEDURAL TERMINOLOGY WILL BE PLACED IN NON-PAY STATUS ON OUR  FILES EFFECTIVE WITH DATE OF SERVICE JULY 1, 2001.  PLEASE PROGRAM ACCORDINGLY.

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CORRECTION TO PREVIOUS NOTICE

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

IN A PREVIOUS NOTICE, THE PRICE FOR PROFESSIONAL SERVICES CODE 88358 WAS STATED AS $199.83.  THIS WAS AN ERROR.  THE ACTUAL PRICE FOR THIS CODE IS $119.83.

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NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

THE FEE FOR CPT CODE 46740 (REPAIR OF HIGH IMPERFORATE ANUS WITH RECTOURETHRAL OR RECTOVAGINAL FISTULA; PERINEAL OR SACROPERINEAL APPROACH) WAS INCREASED TO $1, 086.87 EFFECTIVE WITH DATE OF SERVICE JUNE 1, 2001.

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NOTICE TO PCS/PCA PROVIDERS

THE BUREAU WILL HOLD ANOTHER TRAINING IN JULY FOR PCS/PCA PROVIDERS THAT PROVIDE PCS TO NON-WAIVER RECIPIENTS UNDER AGE 21.  THE TRAINING WILL FOCUS ON COVERED SERVICES AND THE PRIOR AUTHORIZATION PROCESS.  THE DATE OF THE TRAINING IS JULY 13, 2001 AND WILL BE HELD IN ALEXANDRIA.

PROVIDERS WISHING TO ATTEND THE TRAINING MUST CALL TO REGISTER.  PLEASE CALL KAYLIN HAYNES AT 225-342-4182.