RA Messages for July 19, 2005
PHARMACY PROVIDERS, PLEASE NOTE!!!
PLEASE MAKE THE FOLLOWING CHANGES TO THE APPENDIX A:
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
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 FOR USE IN FERTILITY TESTING.
NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES
EFFECTIVE WITH DATE OF SERVICE FEBRUARY 23, 2005, CPT CODE 85576 WILL REQUIRE A QW MODIFIER. THIS NOTICE REPLACES RA MESSAGE OF JUNE 21, 2005
WHICH HAS AN INCORRECT EFFECTIVE DATE.
ATTENTION ANESTHESIA PROVIDERS
THE DEPARTMENT IS AWARE THAT SOME ANESTHESIA CLAIMS UTILIZING THE FORMULA
METHODOLOGY ARE REIMBURSING INCORRECTLY. PROVIDERS WILL BE NOTIFIED WHEN THE PROGRAMMING HAS BEEN CORRECTED AND CLAIMS HAVE BEEN
ADJUSTED.
ATTENTION MEDICAID PROVIDERS
IT IS OUR UNDERSTANDING THAT EFFECTIVE JULY 4, 2005, MEDICARE PART A DISCONTINUED HARD COPY EOMBS ONLY FOR THOSE PROVIDERS WHO CURRENTLY
RECEIVE ELECTRONIC EOMBS. MEDICARE WILL PROVIDE A PRINT-FRIENDLY VERSION OF THESE ELECTRONIC EOMBS THAT CONTAINS ALL INFORMATION PROVIDED ON
HARD COPY EOMBS. LA MEDICAID ACCEPTS COPIES OF ELECTRONIC EOMBS FOR MEDICARE CROSSOVER CLAIMS SO LONG AS THEY ARE THE VERSION THAT PRESENTS
ALL REQUIRED INFORMATION FOR MEDICAID CLAIMS PROCESSING. PLEASE USE THE MEDICARE PRINT-FRIENDLY VERSION AS A PRINTOUT GENERATED FROM YOUR SYSTEM
MAY NOT BE ACCEPTABLE.