RA Messages for July 24, 2007

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 NOTE THE FOLLOWING CHANGES TO APPENDIX C:

LABELER COMPANY  BEGIN  END
00205  LEDERLE PARENTERALS    07/01/07
00304 H.D. SMITH WHOLESALE DRUG COMPANY    07/01/07
10518 DABUR ONCOLOGY PLC 10/01/07   
13668 TORRENT PHARMA, INC. 10/01/07   
24478 NEXTWAVE PHARMACEUTICALS,INC  10/01/07   
50486 BLAIREX LABORATORIES, INC   07/01/07
51817  PHARMASCIENCE LABORATORIES, INC 07/01/07  
53706 DELTA PHARMACEUTICALS, INC    10/01/07 
59417  SHIRE US, INC 10/01/07   
67870 AXIOM PHARMACEUTICAL CORPORATION   10/01/07 

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 DENTAL PROVIDERS

POLICY REMINDER: PER THE 2003 DENTAL SERVICES MANUAL, PROCEDURE CODE D2930 REQUIRES PRIOR AUTHORIZATION FOR TOOTH LETTERS B, I, L AND S FOR RECIPIENTS 8 YEARS OF AGE AND OLDER; AND FOR TOOTH LETTERS A, C, H, J, K, M, R AND T FOR RECIPIENTS 9 YEARS OF AGE AND OLDER. MEDICAID HAS IDENTIFIED THAT CLAIMS FOR PROCEDURE CODE D2930 FOR THESE TOOTH LETTERS FOR 8 AND 9 YEAR OLD AND OLDER RECIPIENTS WERE INCORRECTLY PAID WITHOUT A PRIOR AUTHORIZATION. PROVIDERS ARE REMINDED THAT THEY MUST FOLLOW MEDICAID DENTAL PROGRAM POLICY AND MUST OBTAIN PRIOR AUTHORIZATION WHEN REQUIRED AND INCLUDE THE PRIOR AUTHORIZATION NUMBER ON THE CLAIM FOR PAYMENT.

ATTENTION ALL PROVIDERS

BEGINNING MID-TO-LATE JULY, YOU WILL BEGIN TO SEE NPI(S) POSTED ON THE HARD COPY REMITTANCE ADVICES. THE NPI FOR THE BILLING PROVIDER WILL ONLY APPEAR IF YOU HAVE REGISTERED YOUR NPI WITH LA MEDICAID. THE BILLING NPI WILL APPEAR AT THE UPPER LEFT CORNER OF EACH RA PAGE IMMEDIATELY FOLLOWING THE 7-DIGIT LA MEDICAID BILLING PROVIDER NUMBER. NPI(S) FOR ATTENDING PROVIDER(S) WILL ONLY APPEAR ON THE RA IF THE NPI IS ENTERED
IN THE APPROPRIATE FIELD ON THE CLAIM SUBMITTED FOR PROCESSING. IF THE NPI IS PRESENT ON THE CLAIM IT WILL BE DISPLAYED ON THE RA BY LINE ITEM IN THE FIELD "PHYS NO," IMMEDIATELY FOLLOWING THE 7-DIGIT MEDICAID ID NUMBER OF THE ATTENDING PROVIDER. IF YOU FEEL THE
NPI(S) PRESENTED ON THE RA IS NOT CORRECT FOR THE CORRESPONDING LA MEDICAID PROVIDER NUMBER(S), PLEASE CONTACT THE UNISYS NPI HELP DESK AT 225/216-6400 OR VIA E-MAIL AT LAMEDICAIDNPI@UNISYS.COM

ATTENTION PROVIDERS

EFFECTIVE THE WEEK OF JULY 23, 2007, THE MEDICAL RECORD NUMBER AND THE PATIENT ACCOUNT NUMBER DISPLAYED ON YOUR HARDCOPY REMITTANCE ADVICE (RA) WILL BE EXPANDED. THE MEDICAL RECORD NUMBER WILL BE EXPANDED FROM 20 TO 24 CHARACTERS, AND THE PATIENT ACCOUNT NUMBER WILL BE EXPANDED FROM 16 TO 20 CHARACTERS. THE PLACEMENT OF THIS INFORMATION WILL REMAIN THE SAME; HOWEVER, FOR UB/837I BILLING, BOTH THE PATIENT ACCOUNT NUMBER AND THE MEDICAL RECORD NUMBER WILL BE DISPLAYED TOGETHER WITH A DELIMITER SEPARATING THE TWO NUMBERS; FOR 1500/837P BILLING ONLY ONE OF THESE NUMBERS IS DISPLAYED (PATIENT ACCOUNT NUMBER TAKES PRECEDENCE). THERE ARE SOME PROVIDERS THAT DO NOT RECEIVE THIS INFORMATION ON THE RAS, AND THE INFORMATION WILL NOT BE AVAILABLE AT THIS TIME. IF YOUR RA CURRENTLY DISPLAYS EITHER OF THESE NUMBERS, PLEASE TAKE NOTE OF THIS CHANGE.

ATTENTION PROVIDERS

THE NEW UB04 FORM WILL BE ACCEPTED BY LOUISIANA MEDICAID FOR ALL DATES OF SUBMISSION BEGINNING AUGUST 1, 2007, BUT WILL NOT BE MANDATED FOR USE UNTIL NOVEMBER 5, 2007.
PROVIDERS WILL BE PERMITTED TO USE EITHER THE CURRENT UB92 OR THE NEW UB04 FORM BEGINNING AUGUST 1, 2007 THROUGH NOVEMBER 4, 2007. EFFECTIVE NOVEMBER 5, 2007, THE UB92 FORM WILL BE DISCONTINUED AND ONLY THE NEW UB04 FORM SHALL BE USED. THIS INCLUDES ALL REBILLING OF CLAIMS EVEN THOUGH EARLIER SUBMISSIONS MAY HAVE BEEN ON THE UB92 FORM.