RA Messages for July 26, 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.

PLEASE MAKE SURE THE FOLLOWING CHANGES TO APPENDIX C:

LABELER COMPANY BEGIN END
68817 AMERICAN PHARMACEUTICAL PARTNERS 07/01/05  
67817 ONCOLOGY THERAPEUTICS NETWORK 10/01/05  
68382 ZYDUS PHARMACEUTICAL (USA) INC 10/01/05  

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 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.

ATTENTION IMMUNIZATION PROVIDERS

IMMUNIZATION CLAIMS THAT HAVE IMPROPERLY DENIED WITH ERROR EDITS 233 (PROCEDURE NNON-COVERED FOR SERVICE DATES) OR 675(VACCINE/ADMINISTRATION
CONFLICT) WILL BE RECYCLED AND SHOULD APPEAR ON THE REMITTANCE ADVICE 
OF JULY 19, 2005. 

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2004, THE FOLLOWING CPT CODES WERE ADDED TO THE LIST OF CODES PAYABLE TO CLINICAL NURSE SPECIALIST, CERTIFIED NURSE PRACTITIONER, AND NURSE MIDWIFE. 

17250 AND 94650 

ATTENTION ALL ELECTRONIC CLAIM SUBMITTERS

ONCE THE NEW ANNUAL CERTIFICATION FORM IS ON FILE FOR 2005, INDIVIDUAL CERTIFICATION FORMS FOR EACH FILE TRANSMISSION ARE NO LONGER REQUIRED. ALSO, REMEMBER THAT THE CERTIFICATION FORM IS REQUIRED FOR EACH SUBMITTER NUMBER AND IS NOT REQUIRED FROM PROVIDERS THAT SUBMIT ELECTRONIC CLAIMS THROUGH A THIRD PARTY BILLING AGENT.