RA Messages for June 8, 2004
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.
ON THE TAPE OF 3/8/04, FIRST DATABANK CHANGED THE SIZE AND UNITS
OF RISPERDAL, (50458-0306-11, -0307-11
AND -0308-11) FROM 2(ML) TO 1(UNIT) BUT THEY DID NOT CHANGE THE PRICE UNTIL THE
FOLLOWING WEEK. SO, FOR ONE WEEK CLAIMS FOR THESE NDCS COULD HAVE PAID
INCORRECTLY. PLEASE SUBMIT ADJUSTMENTS IF
NECESSARY.
PLEASE MAKE THE FOLLOWING CHANGES TO THE 5/01/04 VERSION OF
APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 00058 |
NOVARTIS PHARMACEUTICALS CORPORATION |
|
07/01/04 |
| 00369 |
SCHERING CORPORATION |
|
07/01/04 |
| 00372 |
SCOT-TUSSIN PHARMACAL COMPANY, INC. |
|
07/01/04 |
| 00514 |
BERTEK PHARMACEUTICALS, INC. |
|
07/01/04 |
| 52316 |
DSC LABORATORIES DIV DSC PRODUCTS, INC. |
|
07/01/04 |
| 53706 |
DELTA PHARMACEUTICALS, INC. |
04/01/04 |
|
| 53807 |
RIJ PHARMACEUTICAL CORPORATION |
|
07/01/04 |
| 57267 |
NOVARTIS PHARMACEUTICALS CORPORATION |
|
07/01/04 |
| 57459 |
NASTECH PHARMACEUTICAL COMPANY |
|
07/01/04 |
| 58887 |
NOVARTIS
PHARMACEUTICALS CORPORATION |
|
07/01/04 |
| 60242 |
NEIL LABORATORIES, INC |
07/01/04 |
|
| 61113 |
ASTRA ZENECA PHARMACEUTICALS |
|
07/01/04 |
| 61392 |
HEARTLAND SERVICES |
|
07/01/04 |
| 61953 |
GRIFOLS BIOLOGICALS, INC. |
07/01/04 |
|
| 63955 |
GYNETICS |
|
07/01/04 |
| 64248 |
WOMEN'S FIRST HEALTH CARE |
|
07/01/04 |
| 67618 |
PURDUE PRODUCTS, L.P. |
07/01/04 |
|
| 67857 |
REDDY PHARMACEUTICALS |
|
07/01/04 |
| 68180 |
LUPIN PHARMACEUTICALS, INC |
07/01/04 |
|
| 68669 |
VISTAKON PHARMACUTICALS LLC |
07/01/04 |
|
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
ATTENTION RHC/FQHC PROVIDERS
EFFECTIVE WITH DATE OF SERVICE MAY 10, 2004 AND AFTER, MENTAL HEALTH
SERVICES PROVIDED BY A PSYCHIATRIST EMPLOYED BY A RURAL HEALTH CLINIC OR FEDERALLY QUALIFIED HEALTH CENTER WILL NOT REQUIRE A COMMUNITYCARE PCP
REFERRAL AND WILL BE EXCLUDED FROM THE COMMUNITYCARE 106 EDIT. THE PSYCHIATRIST MUST BE ENROLLED AND HAVE AN INDIVIDUAL LA MEDICAID
PROVIDER NUMBER. RHC/FQHC PROVIDERS MUST ENTER THIS INDIVIDUAL PSYCHIATRIST'S 7-DIGIT MEDICAID PROVIDER NUMBER IN BLOCK 24K OF THE CMS-1500 CLAIM FORM (OR THE EQUIVALENT FIELD IF BILLING
ELECTRONICALLY). THIS WILL ALLOW THE CLAIM TO PROCESS PROPERLY. THIS RHC/FQHC EXCLUSION APPLIES
ONLY TO MENTAL HEALTH SERVICES PROVIDED BY A PSYCHIATRIST.
ATTENTION ALL PROVIDERS
THE LA MEDICAID CLAIMS STATUS INQUIRY APPLICATION (E-CSI) IS NOW IN PRODUCTION. THIS NEW APPLICATION IS HIPAA COMPLIANT; ALLOWS PROVIDERS TO
OBTAIN THE STATUS OF CLAIMS SUBMITTED TO LA MEDICAID; AND CAN BE FOUND IN THE SECURE AREA OF THE LA MEDICAID WEBSITE, LAMEDICAID.COM. ONLY
CLAIMS WITH A FINAL DISPOSITION WILL BE ACCESSIBLE FROM THE APPLICATION, I.E. PAID, DENIED, VOIDED, ETC. PROVIDERS WILL NOT BE ABLE TO VIEW
PENDED CLAIMS. TO ENSURE APPROPRIATE SECURITY OF THE RECIPIENT/PROVIDER INFORMATION, PROVIDERS WHO DO NOT CURRENTLY HAVE A LOGIN AND PASSWORD
FOR THIS AREA OF THE WEBSITE MUST OBTAIN ONE IN ORDER TO ACCESS THE APPLICATION. A LOGIN AND PASSWORD MAY BE OBTAINED BY USING THE LINK,
PROVIDER WEB ACCOUNT REGISTRATION INSTRUCTIONS. EFFECTIVE IMMEDIATELY, PROVIDERS WISHING TO CHECK THE STATUS
OF CLAIMS SUBMITTED TO LA MEDICAID SHOULD USE THIS APPLICATION. A DETAILED USER GUIDE ON HOW TO USE THE
APPLICATION CAN BE OBTAINED BY SELECTING THE HELP BUTTON FROM WITHIN THE APPLICATION. SHOULD YOU NEED ASSISTANCE WITH OBTAINING A LOGIN AND PASS
WORD OR HAVE QUESTIONS ABOUT THE TECHNICAL USE OF THE APPLICATION, PLEASE CONTACT THE UNISYS TECHNICAL SUPPORT DESK AT 877-598-8753.
ATTENTION REHABILITATION CENTER PROVIDERS
THE BUREAU OF HEALTH SERVICES FINANCING ANNOUNCES THAT EFFECTIVE IMMEDIATELY, REHABILITATION CENTERS WILL BE ALLOWED TO PROVIDE SPEECH,
OCCUPATIONAL, AND PHYSICAL THERAPY SERVICES IN THE HOMES OF RECIPIENTS WITH PRIOR
APPROVAL FROM THE UNISYS PRIOR AUTHORIZATION UNIT. A RECIPIENT'S PLACE OF RESIDENCE, FOR THESE SERVICES, DOES NOT INCLUDE A
NURSING HOME. REIMBURSEMENT WILL BE MADE AT 110% OF THE CURRENT APPROVED RATE FOR REHABILITATION CENTERS. REQUESTS FOR SERVICES SHOULD BE
SUBMITTED ON UNISYS FORM 101. SERVICES SHOULD BE BILLED WITH UNISYS FORM
102.THE PLACE OF SERVICE FOR HOME MUST BE INDICATED ON THE PA REQUEST AND ON THE CLAIM.