PHARMACY PROVIDERS PLEASE NOTE!!!  

EFFECTIVE JULY 1, 2006, MEDICAID WILL DENY PHARMACY CLAIMS WHEN THERE IS A PRESCRIPTIONS ON THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT FOR THE SAME GENERIC DRUG, WITH THE SAME FORM AND STRENGTH. THE INCOMING CLAIM WILL DENY WITH EOB 893 'SUSPECT DUPLICATE ERROR: IDENTICAL PHARMACY CLAIMS' MAPPED TO NCPDP REJECT CODE 83. PLEASE CALL THE POS HELP DESK AT 1-800-648-0790 OR 225-216-6381 FOR ADDITIONAL INFORMATION IF NEEDED.                          

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.

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.

ATTENTION OUT-OF-STATE PROVIDERS
INPATIENT ACUTE CARE 

OUT-OF-STATE HOSPITALS WHICH PROVIDED INPATIENT SERVICES TO LOUISIANA MEDICAID HURRICANE KATRINA EVACUEES HAVE RECEIVED NUMEROUS DENIALS ON INPATIENT CLAIMS. ONLY THOSE CLAIMS WHICH RECEIVED A DENIAL CODE OF 532-OUT-OF-STATE SERVICE REQUIRES DHH APPROVAL LETTER, ARE BEING REPROCESSED. THEREFORE PROVIDERS MUST CONTACT THE PROVIDER RELATIONS HELPDESK AT 1-800-473-2783 FOR ASSISTANCE IN CORRECTING AND RESUBMITTING CLAIMS WHICH DENIED FOR ANY OTHER REASON. 

ATTENTION ALL PROVIDERS

AN ADDITIONAL YEAR-END CHECKWRITE DATED 06/29/06 WILL BE RUN THIS WEEK. ALL PROCESSED CLAIMS AND AUDIT TRANSACTIONS WILL APPEAR ON THIS SPECIAL CHECKWRITE. BECAUSE OF THIS, THE PAYMENT AMOUNT AND PROPRIETARY ELECTRONIC RAS FOR THE 06/27/06 CHECKWRITE WILL BE ON REVS AND THE BBS ONLY UNTIL 06/29/06 WHEN IT WILL BE OVERLAYED WITH THE NEW INFORMATION FOR THE 06/29/06 CHECKWRITE. THE PAYMENT AMOUNT AND ELECTRONIC RAS FOR 06/29/06 WILL REMAIN ON REVS AND THE BBS ONLY UNTIL 07/02/06 WHEN IT WILL BE OVERLAYED WITH NEW INFORMATION FOR THE REGULAR 07/04/06 CHECKWRITE. PLEASE BE AWARE THAT A PORTION OF ANY PAYMENTS GENERALLY EXPECTED ON THE 07/04/06 CHECKWRITE MAY APPEAR IN THE 06/29/06 CHECKWRITE, THUS, AFFECTING YOUR PAYMENT FOR 07/04/06. FOR QUESTIONS ABOUT ELECTRONIC RAS, CALL EDI AT 225/216-6000,X2. FOR ALL OTHER QUESTIONS, CALL UNISYS 
PROVIDER RELATIONS AT (800)473-2783 OR (225)924-5040.