RA Messages for July 2, 2002
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 FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN
INCORRECTLY PAID.
ATTENTION ALL PROVIDERS
THE LOUISIANA MEDICAID PROGRAM ANNOUNCES THAT EFFECTIVE JULY 1, 2002, A
HOSPICE PROGRAM WILL BE IMPLEMENTED TO PROVIDE SERVICES TO TERMINALLY ILL RECIPIENTS.
ONCE A RECIPIENT ELECTS TO RECEIVE HOSPICE SERVICES, THE HOSPICE AGENCY IS RESPONSIBLE FOR EITHER PROVIDING OR PAYING FOR ALL COVERED SERVICES
RELATED TO THE TREATMENT OF THE RECIPIENT'S TERMINAL CONDITION. THEREFORE, ANY CLAIMS FOR SERVICES RELATED TO THE TERMINAL ILLNESS
SUBMITTED BY A PROVIDER, OTHER THAN THE ELECTED HOSPICE AGENCY, WILL BE DENIED FOR ERROR EDIT CODE 493 - "NON-HOSPICE PROVIDER/SUBMIT
JUSTIFICATION FOR SERVICES." IF THE CLAIM IS NOT RELATED TO THE TERMINAL ILLNESS THE PROVIDER SHOULD SUBMIT THE CLAIM WITH ATTACHED
JUSTIFICATION SUFFICIENT TO ESTABLISH THAT THE SERVICE WAS MEDICALLY NECESSARY AND WAS NOT RELATED TO THE TERMINAL CONDITION. CLAIMS FOR
PRESCRIPTION DRUGS AND HOME AND COMMUNITY BASED WAIVER SERVICES WILL NOT BE SUBJECT TO ERROR EDIT CODE 493. HOWEVER, THESE SERVICES WILL BE
SUBJECT TO POST-PAYMENT REVIEW AND RECOUPMENT MAY BE IMPOSED IF IT IS DETERMINED THAT THE SERVICE WAS
RELATED TO THE TREATMENT OF THE TERMINAL ILLNESS.