RA Messages for August 14, 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 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 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.
ATTENTION PROVIDERS
THE 2007 ANNUAL PROVIDER TRAINING
WORKSHOPS WILL BEGIN IN SEPTEMBER. THE DETAILED TRAINING SCHEDULE WILL
BE AVAILABLE ON THE LA MEDICAID WEBSITE WWW.LAMEDICAID.COM TRAINING LINK
SHORTLY. PLEASE WATCH THE WEBSITE AND RA MESSAGES/STUFFERS FOR DETAILS.
ATTENTION PROVIDERS
WITH THE IMPLEMENTATION OF THE
NATIONAL PROVIDER IDENTIFIER AND CHANGES IN CLAIMS PROCESSING
GUIDELINES, LA MEDICAID WILL NO LONGER BE ABLE TO BILL MEDICARE DIRECTLY
WHEN RECIPIENTS ARE MEDICARE ELIGIBLE & MEDICAID HAS ALREADY PAID THE
CLAIM. THUS, IN THESE CASES, LA MEDICAID RECENTLY BEGAN RECOUPING THESE
PAYMENTS DIRECTLY FROM PROVIDERS. RECENTLY, THE IDENTIFICATION OF CLAIMS
FOR THE INITIAL QUARTERLY RECOUPMENT WHICH INCLUDES THIS NEW PROGRAMMING
WAS DONE, & LETTERS MAILED TO AFFECTED PROVIDERS. BECAUSE OF AN ERROR IN
THE NEW LOGIC, SOME PROVIDERS WHO SHOULDN'T HAVE BEEN INCLUDED IN THE
RECOUPMENT RECEIVED LETTERS. MANY OF THESE PROVIDERS QUICKLY NOTIFIED US
OF THIS PROBLEM, AND WE WERE ABLE TO IDENTIFY THE ERROR AND CORRECT THE
PROGRAMMING BEFORE ANY MONIES WERE ERRONEOUSLY RECOUPED. WE APPRECIATE
THE SPEEDY ACTION BY THE PROVIDER COMMUNITY AND ARE PLEASED THAT BECAUSE
THE PROCESS WORKED NO RECOUPMENTS WERE MADE PRIOR TO THE IDENTIFICATION
AND CORRECTION OF THE PROBLEM.
ATTENTION PHARMACISTS
EFFECTIVE AUGUST 19, 2007, A
TRANSITION PERIOD WHICH WILL ALLOW BILLING POINT OF SALE PHARMACY CLAIMS
TO LOUISIANA MEDICAID WITH EITHER THE PROVIDER'S MEDICAID NUMBER OR THE
PROVIDER'S NATIONAL PROVIDER IDENTIFIER (NPI) WILL OCCUR.
THE NCPDP 5.1 FORMAT PERMITS ONLY A
SINGLE BILLING PHARMACY IDENTIFIER, THUS THE QUALIFIERS WILL BECOME VERY
IMPORTANT DATA ELEMENTS FOR DETERMINING THE TYPE OF IDENTIFIER SUBMITTED
DURING THE TRANSITION PERIOD. DHH IS ADVISING PHARMACY PROVIDERS TO
CONTACT THEIR SOFTWARE VENDOR TO INSURE THAT THEIR SOFTWARE IS ABLE TO
TRANSMIT AN NPI, SINCE PROGRAMMING CHANGES OR A CHANGE IN THE SOFTWARE
"SET-UP" FOR MEDICAID BILLING MAY BE REQUIRED.
A DATE FOR ACCEPTING NPI-ONLY FOR THE
PHARMACY BILLING HAS NOT BEEN DETERMINED ALTHOUGH IT IS ANTICIPATED THAT
THIS WILL TAKE PLACE PRIOR TO MAY 23, 2008. ALSO, NO DETERMINATION HAS
BEEN MADE REGARDING ACCEPTING NPI-ONLY FOR THE PRESCRIBER. LOUISIANA
MEDICAID PLANS TO MAKE REGISTERED PRESCRIBER NUMBERS AVAILABLE TO
PHARMACIES AND THEIR SOFTWARE VENDORS AS SOON AS A SIGNIFICANT NUMBER
ARE AVAILABLE.
AT THIS TIME, IT IS NECESSARY TO
CONTINUE TO COMPLETE THE NCPDP UNIVERSAL PAPER CLAIM FORM WITH THE
MEDICAID ID AND NOT THE NPI FOR BOTH THE PHARMACY AND PRESCRIBER FIELDS.
PHARMACY PROVIDERS HAVE RECEIVED A DETAILED LETTER REGARDING CLAIM
SUBMISSION WITH THE NPI AND APPROPRIATE QUALIFIERS. ANY QUESTIONS
REGARDING THE BILLING OF PHARMACY CLAIMS WITH NPIS SHOULD BE DIRECTED TO
THE PHARMACY POS HELPDESK AT 1-800-648-0790 OR 225-216-6381.