RA Messages from July 12, 1999
ATTENTION: PHARMACY PROVIDERS
IN ACCORDANCE WITH THE FISCAL YEAR 1999-2000 GENERAL APPROPRIATION ACT,
THE DEPARTMENT OF HEALTH AND HOSPITALS WILL CHANGE ESTIMATED ACQUISITION
COST REIMBURSEMENT FOR PRESCRIPTION DRUGS TO:
AVERAGE WHOLESALE PRICE(AWP) MINUS 13.5% FOR ALL SINGLE SOURCE DRUGS
(BRAND NAME), MULTIPLE SOURCE DRUGS WHICH DO NOT HAVE A STATE MAXIMUM
ALLOWABLE COST OR FEDERAL UPPER LIMIT AND THOSE PRESCRIPTIONS WHICH
ARE SUBJECT TO MAC OVERRIDES BASED ON THE PHYSICIAN'S CERTIFICATION
THAT A BRAND NAME PRODUCT IS MEDICALLY NECESSARY FOR A PARTICULAR
RECIPIENT FOR CHAIN PHARMACIES ONLY. CHAIN PHARMACIES ARE DEFINED AS
FIVE OR MORE MEDICAID ENROLLED PHARMACIES UNDER COMMON OWNERSHIP.
THIS REIMBURSEMENT CHANGE IS EFFECTIVE FOR SERVICES BEGINNING JULY 1,
1999.
ALL OTHER MEDICAID-ENROLLED PHARMACIES ARE DEFINED AS INDEPENDENT AND
WILL REMAIN AT THE ESTIMATED ACQUISITION COST REIMBURSEMENT OF AWP
MINUS 10.5%
EFFECTIVE FOR DATES OF SERVICE BEGINNING JULY 1,1999, LOUISIANA MED-
ICAID WILL LIMIT PAYMENTS FOR PRESCRIPTION DRUGS TO THE LOWER OF:
* ESTIMATED ACQUISITION COST WHICH IS DEFINED AS AVERAGE WHOLESALE
PRICE MINUS 10.5% FOR INDEPENDENT PHARMACIES AND 13.5% FOR CHAIN
PHARMACIES, FOR ALL SINGLE SOURCE DRUGS (BRAND NAME), MULTIPLE
SOURCE DRUGS WHICH DO NOT HAVE A STATE MAXIMUM ALLOWABLE COST OR
FEDERAL UPPER LIMIT AND THOSE PRESCRIPTIONS WHICH ARE SUBJECT TO
MAC OVERRIDES BASED ON THE PHYSICIAN'S CERTIFICATION THAT A
BRAND NAME PRODUCT IS MEDICALLY NECESSARY FOR A PARTICULAR
RECIPIENT PLUS THE MAXIMUM ALLOWABLE OVERHEAD COST (DISPENSING
FEE).
* LOUISIANA MAXIMUM ALLOWABLE COST LIMITATION PLUS THE MAXIMUM
ALLOWABLE OVERHEAD COST:
* FEDERAL UPPER LIMIT PLUS THE MAXIMUM ALLOWABLE COST; OR
* PROVIDER'S USUAL AND CUSTOMARY CHARGE TO THE GENERAL PUBLIC.
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
PLEASE MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRENGTH |
MAC |
EFF.DATE |
| ALLOPURINOL SODIUM |
VIAL |
500MG |
|
06/28/99
|
| CERVISTATIN SODIUM |
TABLET |
0.4 |
|
06/04/99 |
| CYTABARINE LIPOSOME |
VIAL |
50MG/5ML |
|
06/18/99 |
| DOXYCYCLINE HYCLATE |
CAPSULE |
20MG |
|
04/01/99 |
| ISOSORBIDE DINITRATE |
TABLET |
30MG |
OFF MAC |
06/21/99 |
| MINOCYCLINE HCL |
CAPSULE |
75MG |
|
06/15/99 |
| OXYBUTYNIN CHLORIDE |
TAB SA OSM |
15MG |
|
06/24/99 |
| PERINDOPRIL ERBUMINE |
TABLET |
2MG,4MG,8MG |
|
07/15/99 |
| **PROBENECID |
TABLET |
500MG |
** 0.43950 |
07/01/99 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
ATTENTION ALL PROVIDERS- RECIPIENTS NEW PERMENANT ID
IF YOU RELY ON ANOTHER ENTITY (I.E., BILLING SERVICE, CLEARINGHOUSE,
ETC.)TO BILL CLAIMS OR RECONCILE ACCOUNTS ON YOUR BEHALF, PLEASE SHARE
THE INFORMATION WITH THEM.IF THESE ENTITIES ARE NOT INFORMED AND/OR ARE
NOT Y2K READY, IT COULD CAUSE ADDITIONAL DIFFICULTY FOR YOU!
BEGINNING JULY 6, 1999, A PERMANENT 13 DIGIT RECIPIENT NUMBER WILL BE
ASSIGNED TO EACH MEDICAID RECIPIENT. ALTHOUGH THE PERMANENT NUMBER WILL
FREQUENTLY LOOK THE SAME AS THE CURRENT MEDICAID RECIPIENT IDENTIFI-
CATION NUMBER ASSIGNED TO A RECIPIENT, THIS NUMBER WILL NOT DENOTE ANY
INFORMATION RELATED TO PARISH OR ELIGIBILITY TYPE. EACH RECIPIENT ON
FILE AS OF 6/30/99 WILL HAVE THE MOST CURRENT 13 DIGIT NUMBER SELECTED
AS THE PERMANENT NUMBER. THIS DOES NOT MEAN THE OTHER ID NUMBERS ISSUED
TO RECIPIENTS CANNOT BE USED TO BILL. IN FACT, WHEN BILLING FOR SERVICES
WHICH HAVE BEEN PRE-CERTIFIED OR PRIOR AUTHORIZED, IT WILL BE NECESSARY
TO BILL USING THE NUMBER UNDER WHICH THE PRECERTIFICATION OR PRIOR
AUTHORIZATION WAS ISSUED. BEGINNING 7/99, WE ENCOURAGE PROVIDERS TO
MAKE NOTE OF THE IDENTIFICATION NUMBER CONFIRMED OR OBTAINED FROM
UNISYS REVS TELEPHONE INQUIRY OR THE MEVS AUTOMATED INQUIRY SYSTEM AS
THIS WILL BE THE PERMANENT NUMBER.
IT IS IMPORTANT THAT YOU ACCESS REVS OR MEVS TO VERIFY ELIGIBILITY. IF
YOU RELY ON ANOTHER ENTITY(I.E., BILLING SERVICE, CLEARINGHOUSE, ETC.)TO
BILL CLAIMS OR RECONCILE ACCOUNTS ON YOUR BEHALF, PLEASE SHARE THIS INF-
ORMATION WITH THEM.IF THESE ENTITIES ARE NOT INFORMED AND/OR ARE NOT Y2K
READY, IT COULD CAUSE ADDITIONAL DIFFICULTY FOR YOU.
ATTENTION EYEGLASS PROVIDERS
MEDICAID REIMBURSEMENT RATES FOR EYEGLASS FRAMES WERE INCREASED EFFECT-
IVE JULY 1, 1999. THIS INCREASE OCCURRED FOR PROCEDURE CODES X6370
THROUGH X6376. THE NEW REIMBURSEMENT RATES, ALONG WITH A COVER LETTER
EXPLAINING THE CHANGES, WERE DISTRIBUTED TO ALL EYEGLASS PROVIDERS IN
JUNE 1999.A CHANGE IN EYEGLASS FRAME POLICY WAS IMPLEMENTED WITH THIS
INCREASE.EFFECTIVE JULY1, 1999, MEDICAID RECIPIENTS MUST BE OFFERED A
CHOICE BETWEEN METAL OR PLASTIC FRAMES. THE FRAMES SHOULD BE STURDY AND
NON-FLAMMABLE. BOTH THE METAL AND NONMETAL FRAMES SHOULD CARRY AT LEASTA 1-YEAR MANUFACTURER'S WARRANTY. OTHER EYEGLASS POLICY REMAINS
UNCHANGED. CALL UNISYS PROVIDER RELATIONS (1-800-473-2783) WITH ANY QUESTIONS.
Document : Medicaid | Department of Health | State of Louisiana |Date Modified : 05/12/2025 05:49:30