RA Messages for July 12, 2005

PHARMACY PROVIDERS, PLEASE NOTE!!!

PLEASE MAKE THE FOLLOWING CHANGES TO THE APPENDIX A: 

DRUG  DOSAGE  STRGTH MAC EFF.DATE 
LORATADINE SYRUP 5MG/ML $0.06658 7/01/05 
LORATADINE TAB  RAPDIS 10MG $0.63333 7/01/05 
LORATADINE TABLET 10MG  $0.27990 7/01/05 
LORATADINE/P-EPHED SULF TABLET SR 5-120MG  $0.76900 7/01/05 
LORATADINE/P-EPHED SULF TABLET SR 10-240MG $0.89900 7/01/05 

THE FOLLOWING ARE BEING REMOVED FROM MAC STATUS EFFECTIVE 1/01/05:

FE FUMARATE/VIT C/B12-IF/FA CAPSULES
GRISEOFULVIN MICROSIZE TAB 250MG
MTH/ME BLUE/BA/SALICYL/ATP/HYOS TABLETS
NIACIN SA TABLETS, 500MG AND750 MG.

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 PHARMACY PROVIDERS

PHARMACY VOID CLAIMS THAT WERE INCORRECTLY DENIED FOR ERROR 799 (NO HISTORY RECORD ON FILE FOR THIS ADJUSTMENT) IN THE JUNE 21, 2005 RA ARE BEING RESUBMITTED FOR CORRECT PROCESSING IN THE JULY 12, 2005 RA. PLEASE CONTACT UNISYS PBM HELP DESK AT 800-648-0790 IF YOU HAVE ANY QUESTIONS REGARDING THIS MATTER. 

ATTENTION DENTAL PROVIDERS

TO ENSURE PROPER HANDLING OF THE REQUESTS FOR PRIOR AUTHORIZATION FOR SERVICES COVERED IN THE EXPANDED DENTAL SERVICES FOR PREGNANT WOMEN (EDSPW) PROGRAM, WE ASK THAT THE BHSF FORM 9-M BE PLACED ON TOP OF THE ADA CLAIM FORM AND OTHER DOCUMENTS (I.E., RADIOGRAPHS) FOR EACH PRIOR AUTHORIZATION REQUEST SENT TO THE DENTAL PRIOR AUTHORIZATION UNIT. 

OBSTETRIC ANESTHESIA BILLING CLARIFICATION

WHEN BILLING CPT CODE 01967 WITH ADD ON CODE + 01968 OR ADD ON CODE + 01969, BOTH CODES MUST BE BILLED WITH THE SAME DATE OF SERVICE (DATE OF DELIVERY) TO PROCESS CORRECTLY. TOGETHER THE TWO CODES FORM ONE COMPLETE SERVICE. 

ATTENTION DME AND PHARMACY PROVIDERS

UNISYS PRIOR AUTHORIZATION HAS BEEN INSTRUCTED TO DENY ALL REQUESTS FOR DME AND SUPPLIES FOR RECIPIENTS RESIDING IN NURSING HOMES AND INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED ON OR AFTER JULY 1, 2005. ANY PENDING REQUESTS FOR AUTHORIZATION OF PAYMENT OF SUPPLIES RECEIVED PRIOR TO JULY 1,2005 CAN ONLY BE APPROVED THROUGH JUNE 30,2005.REQUESTS FOR THIS POPULATION'S EQUIPMENT AND SUPPLIES APPROVED BY JUNE 30, 2005 WILL BE HONORED. 

ATTENTION PROVIDERS OF CONSCIOUS SEDATION

THE DEPARTMENT IS AWARE THAT CPT CODES 99141 AND 99142 BILLED WITH SURGICAL CODES HAVE BEEN INCORRECTLY DENYING WITH ERROR MESSAGE 791. PROVIDERS WILL BE NOTIFIED WHEN THE PROGRAMMING HAS BEEN CORRECTED. LOUISIANA MEDICAID HAS ADOPTED THE 2005 CPT GUIDELINES WHICH LISTS PROCEDURES THAT INCLUDE CONSCIOUS SEDATION AS AN INHERENT PART OF PROVIDING THE PROCEDURE. CLAIMS PAID INAPPROPRIATELY ARE SUBJECT TO RECOUPMENT.

ATTENTION PHYSICIANS - INHIBIN A (CPT CODE 86336)

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2005, LOUISIANA MEDICAID HAS PUT CPT CODE 86336 FOR INHIBIN A TESTING IN 'PAY' STATUS. THIS TEST IS USED IN SCREENING FOR FETAL ABNORMALITIES AND COVERAGE IS NOT INTENDED FOR USE IN FERTILITY TESTING.