DETAILED LABELER CHANGES ARE POSTED ON WWW.LAMEDICAID.COM                 

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 PRESCRIBING PROVIDERS AND PHARMACY PROVIDERS

EFFECTIVE AUGUST 1, 2006 PHARMACY CLAIMS FOR COMBINATION ACETAMINOPHEN PRODUCTS WILL DENY WHEN THE DOSE OF ACETAMINOPHEN EXCEEDS FOUR (4) GRAMS PER DAY.  THE PHARMACY CLIAMS WILL DENY WITH NCPDP REJECTION CODE 88 (DUR REJECT ERROR) MAPPED TO EOB CODE 529 (EXCEEDS MAXIMUM DAILY DOSE).  REFER TO CORRESPONDENCE DATED JUNE 23, 2006.

ATTENTION ALL PROVIDERS - NATIONAL PROVIDER IDENTIFIER

DHH HAS LAUNCHED A NEW NPI WEB REGISTRATION SITE FOR PROVIDERS TO REGISTER THEIR NPI WITH LOUISIANA MEDICAID. CMS WILL REQUIRE ALL HIPAA STANDARD TRANSACTIONS, INCLUDING MEVS ELIGIBILITY INQUIRY AND CLAIMS STATUS INQUIRY TO BE SUBMITTED USING THE NPI NUMBER BEGINNING 23-MAY-07.THE NEW NPI APPLICATION IS ACCESSIBLE FROM THE LIST OF APPLICATIONS IN THE SECURED PROVIDER AREA OF THE WWW.LAMEDICAID.COM WEB SITE. FIND THIS AND MORE ON THE NPI INFORMATION PAGE ACCESSIBLE FROM WWW.LAMEDICAID.COM>HIPAA INFORMATION CENTER>NATIONAL PROVIDER IDENTIFIER (NPI).

ATTENTION UCC PROVIDERS:

BEGINNING AUGUST 1, 2006 YOU CAN START SUBMITTING ADJUSTMENTS, VOIDS AND RESUBMITS OF DENIED CLAIMS. YOU WILL HAVE UNTIL SEPTEMBER 15, 2006 AT MIDNIGHT TO COMPLETE THE ABOVE REFERENCED TRANSACTIONS. THESE MAY BE SUBMITTED USING THE UCC WEB APPLICATION ONLY. NO PAYMENTS WILL BE MADE AFTER SEPTEMBER 30, 2006. REFERENCE THE UCC WEB USER GUIDE FOR INSTRUCTIONS AT 
<HTTP://WWW.LAMEDICAID.COM/PROVWEB1/HURRICANERELIEFPOOLPLAN.HTM>

COMMUNITYCARE BILLING REMINDER

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2002 DHH ESTABLISHED A PROCEDURE FOR PHYSICIANS TO IDENTIFY HIGH-LEVEL EMERGENCY ROOM VISITS (99283- 99285) AND ASSOCIATED SERVICES. EMERGENCY ROOM PHYSICIANS, BILLING ON THE CMS 1500 SHOULD PUT A "3" IN LOCATOR 24I TO IDENTIFY ALL SERVICES ASSOCIATED WITH A HIGH-LEVEL EMERGENCY ROOM VISIT. HIGH-LEVEL EMERGENCY ROOM VISITS DO NOT REQUIRE POST-AUTHORIZATION BY THE COMMUNITYCARE PCP. THE USE OF THE "3" WITH LOW LEVEL (99281-99282) EMERGENCY ROOM VISITS AND ASSOCIATED SERVICES IS CONSIDERED FRAUDULENT BILLING AND IS SUBJECT TO RECOUPMENT.