RA Messages for July 5, 2005

PHARMACY PROVIDERS, PLEASE NOTE!!!


EFFECTIVE WITH DATE OF SERVICE OF JULY 1, 2005, ERECTILE DYSFUNCTION MEDICATION WILL NO LONGER BE REIMBURSED BY MEDICAID.  CLAIMS FOR THESE MEDICATIONS WILL DENY WITH ERROR CODE 299 (PRODUCT/DRUG NOT COVERED BY MEDICAID) WHICH IS LINKED TO NCPDP REJECTION CODE 70 (PRODUCT/SERVICE NOT COVERED). 

PLEASE MAKE THE FOLLOWING CHANGES TO THE APPENDIX A: 

DRUG  DOSAGE  STRGTH MAC EFF.DATE 
LORATADINE SYRUP 5MG/ML $0.06658 7/01/05 
LORATADINE TAB  RAPDIS 10MG $0.63333 7/01/05 
LORATADINE TABLET 10MG  $0.27990 7/01/05 
LORATADINE/P-EPHED SULF TABLET SR 5-120MG  $0.76900 7/01/05 
LORATADINE/P-EPHED SULF TABLET SR 10-240MG $0.89900 7/01/05 

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

CLARIFICATION FOR BILLING OUTPATIENT PROCEDURES
EXCLUDED FROM AMBULATORY SURGICAL LIST

AS A RESULT OF CHANGES TO THE BILLING OF AMBULATORY SURGICAL PROCEDURES EFFECTIVE 3/1/05, THE FOLLOWING INSTRUCTIONS WILL FURTHER CLARIFY THE REBILLING OF SOME HCPCS CODES WHICH ARE NO LONGER ON THE AMBULATORY SURGICAL LIST.

ALL EMERGENCY ROOM VISITS MUST BE BILLED USING REVENUE CODE 450 OR 459. THE APPLICABLE HCPCS/CPT CODE FOR THE VISIT MUST BE LISTED UNDER LOCATOR 44 (I.E., 99281-99285). ONLY ONE "450" OR "459" MAY BE BILLED PER OUTPATIENT VISIT.  ALL OTHER ASSOCIATED CHARGES SUCH AS LABS, SUPPLIES, X-RAYS, ETC., ARE TO BE BILLED AS SEPARATE LINE ITEMS USING THEIR SPECIFIC REVENUE CODES. REFER TO THE 2002 LOUISIANA MEDICAID HOSPITAL TRAINING PACKET PAGE 5 FOR FURTHER INFORMATION.

IF IT IS DETERMINED THAT THE PATIENT MUST BE MOVED FROM THE EMERGENCY ROOM TO ANOTHER ROOM FOR SPECIALIZED TREATMENT, THE APPROPRIATE REVENUE CODE FOR THE SECOND ROOM MUST BE BILLED WITH THE APPLICABLE HCPCS CODE FOR THE PROCEDURE IN ADDITION TO THE EMERGENCY ROOM. EXAMPLES OF THESE SECONDARY ROOMS INCLUDE TREATMENT ROOM (HR 760, 762, 764, OR 769), OBSERVATION ROOM (HR 760), OR CAST ROOM (HR 700). FOR SERVICES PROVIDED IN A CLINIC SETTING ON AN OUTPATIENT BASIS, THE FACILITY FEE FOR THE HOSPITAL'S CHARGES MUST BE BILLED USING THE APPROPRIATE REVENUE CODES 510, 514, 515, 517, OR 519 WITH THE APPLICABLE HCPCS CODE.

WHILE SOME HCPCS CODES MAY EVENTUALLY BE ADDED TO THE AMBULATORY SURGICAL LIST, NO DECISIONS HAVE BEEN MADE AT THIS TIME. PROVIDERS WILL BE NOTIFIED WHEN CHANGES OCCUR.  ADDITIONAL QUESTIONS MAY BE DIRECTED TO PROVIDER RELATIONS AT 1-800-473-2783.

ATTENTION DENTAL PROVIDERS

TO ENSURE PROPER HANDLING OF THE REQUESTS FOR PRIOR AUTHORIZATION FOR SERVICES COVERED IN THE EXPANDED DENTAL SERVICES FOR PREGNANT WOMEN (EDSPW) PROGRAM, WE ASK THAT THE BHSF FORM 9-M BE PLACED ON TOP OF THE ADA CLAIM FORM AND OTHER DOCUMENTS (I.E., RADIOGRAPHS) FOR EACH PRIOR AUTHORIZATION REQUEST SENT TO THE DENTAL PRIOR AUTHORIZATION UNIT. 

ATTENTION PROFESSIONAL SERVICE PROVIDERS

THIS RAS DATED 6/28/05 AND 7/5/05 REFLECT CLAIMS BEING RECYCLED TO PAY AN ENHANCED RATE APPROVED FOR CERTAIN SERVICES PROVIDED TO CHILDREN 0-15 YEARS OF AGE. THE ENHANCED RATE AND RECYCLE APPLY TO DATES OF SERVICE 01/01/04 FORWARD.

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.