RA Messages for August 16, 2005

PHARMACY PROVIDERS, PLEASE NOTE!!!

PLEASE MAKE THE FOLLOWING CHANGES TO THE APPENDIX A: 

THE FOLLOWING ARE BEING REMOVED FROM MAC STATUS EFFECTIVE 7/01/05:

ALL ANTIHEMOPHILIC FACTOR KITS AND VIALS
FACTOR IX COMPLEX HUMAN VIAL
ISOSORBIDE DINITRATE SA TABS, 40MG
LINDANE LOTION1%
PREDNISOLONE SOD PHOS SOL, 15MG/5ML
PV W-O VIT A/FE FUMARATE/FA TABS 40-1MG
TEMAZEPAM CAPSULE 7.5MG

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

SCHEDULE II NARCOTIC ANALGESICS

PREVIOUSLY, PRESCRIPTIONS FOR SCHEDULE II NARCOTIC ANALGESICS HAD TO BE FILLED WITHIN 5 DAYS OF THE DATE OF THE PRESCRIPTION. THIS POLICY, HOWEVER, HAS BEEN REVISED, EFFECTIVE WITH DATE OF SERVICE AUGUST 20,2005.  THE NEW POLICY STATES THAT PRESCRIPTIONS FOR SCHEDULE II NARCOTIC ANALGESICS SHALL BE FILLED WITHIN 6 MONTHS OF THE DAY THE PRESCRIPTION WAS WRITTEN. A DENIAL ERROR CODE OF #454 (NEW PRESCRIPTION NOT FILLED WITHIN 6 MONTHS OF THE DATE PRESCRIBED), WHICH IS CROSS-REFERENCED TO NCPDP CODE M4, WILL APPLY TO THOSE PRESCRIPTIONS FILLED AFTER 6 MONTHS FROM THE DATE WRITTEN.

ATTENTION MEVS/EMEVS USERS

EFFECTIVE SUNDAY, JULY 24, 2005, THE REQUIREMENTS FOR THE NAME IDENTIFICATION OPTIONS TO THE MEVS/EMEVS SYSTEMS HAS BEEN INCREASED FOR THE FIRST NAME FROM 7 CHARACTERS TO A MINIMUM OF 14 CHARACTERS. AN EXACT MATCH FOR THE LAST NAME HAS INCREASED FROM 12 CHARACTERS TO A MINIMUM OF 17 CHARACTERS. ANY FIRST OR LAST NAME THAT IS SHORTER THAN THESE MINIMUMS MUST BE ENTERED FULLY TO GET A NAME MATCH. NAMES THAT EXCEED THESE MINIMUM LENGTHS MUST CONTAIN AT LEAST THE NEW MINIMUM NUMBER OF CHARACTERS TO GET A NAME MATCH. 

ATTENTION PROFESSIONAL SERVICE PROVIDERS
HOSPITAL OBSERVATION CARE 

LOUISIANA MEDICAID CONSIDERS "INITIAL OBSERVATION CARE," CPT CODES 99218 - 99220, A PART OF THE EVALUATION AND MANAGEMENT SERVICES PROVIDED TO PATIENTS THAT ARE DESIGNATED AS "OBSERVATION STATUS" IN A HOSPITAL. THE KEY COMPONENTS OF THE CODES USED TO REPORT PHYSICIAN ENCOUNTER(S) ARE DEFINED IN CPT'S "EVALUATION AND MANAGEMENT SERVICES GUIDELINES." THESE GUIDELINES INDICATE THAT PROFESSIONAL SERVICES INCLUDE THOSE FACE-TO- FACE AND/OR BEDSIDE SERVICES RENDERED BY THE PHYSICIAN AND REPORTED BY THE APPROPRIATE CPT CODE. IN ORDER TO SUBMIT CLAIMS TO THE LOUISIANA MEDICAID PROGRAM FOR HOSPITAL OBSERVATION CARE, THE SERVICE PROVIDED BY THE PHYSICIAN MUST INCLUDE FACE-TO-FACE AND/OR BEDSIDE CARE.

ATTENTION ALL COMMUNITYCARE PROVIDERS

COMMUNITYCARE PROVIDERS WHO PREVIOUSLY RECEIVED COMMUNITYCARE PROVIDER UTILIZATION REPORTS WILL NO LONGER RECEIVE THEM, EFFECTIVE WITH THE APRIL 2005 REPORT. THE DEPARTMENT OF HEALTH AND HOSPITALS (DHH) HAS TEMPORARILY CEASED DISTRIBUTION OF THESE REPORTS. DHH WILL BE WORKING WITH UNISYS TO DEVELOP A NEW, MORE ACCURATE REPORT. QUESTIONS REGARDING THIS ISSUE MAY BE DIRECTED TO THE COMMUNITYCARE PROGRAM OFFICE AT (225)342-1304. 

ATTENTION PHYSICIANS

SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC 
IMAGING AGENT THALLOUS CHLORIDE TL 201/MCI 

DELETED CPT CODE 78990 HAS BEEN PLACED IN NON-PAY STATUS EFFECTIVE JUNE 1, 2005. HCPCS CODE A9505 (SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, THALLOUS CHLORIDE TL 201/MCI) HAS BEEN MADE PAYABLE EFFECTIVE JANUARY 1, 2005, AT 80% OF THE REGION 99 MEDICARE ALLOWABLE. CLAIMS FOR THIS IMAGING AGENT MAY NOW BE SUBMITTED ELECTRONICALLY AS AN INVOICE WILL NO LONGER BE REQUIRED. 

PHYSICIAN ASSISTANT UPDATE

IMPLEMENTATION OF THE PROCESSING OF CLAIMS FOR PHYSICIAN ASSISTANT SERVICES EFFECTIVE WITH DATE OF SERVICE 7/1/2005, HAS BEEN DELAYED. PROVIDERS ARE ASKED TO HOLD CLAIMS FOR THESE SERVICES UNTIL NOTIFIED BY THE DEPARTMENT. IT IS ANTICIPATED THAT THE SYSTEM WILL BE READY TO PROCESS PHYSICIAN ASSISTANT CLAIMS WITHIN THE NEXT SEVERAL WEEKS. PLEASE MONITOR FUTURE RA MESSAGES WHICH WILL INFORM PROVIDERS WHEN THESE CLAIMS MAY BE SUBMITTED. 

CERTIFIED NURSE PRECTITIONER, CLINICAL NURSE SPECIALIST 
AND CERTIFIED NURSE MIDWIFE UPDATE 


THE EFFECTIVE DATE OF IMPLEMENTATION OF THE CHANGES IN REIMBURSEMENT METHODOLOGY FROM A "LIST" OF BILLABLE SERVICES TO COVERED SERVICES DETERMINED BY LICENSURE AND SCOPE OF PRACTICE HAS BEEN CHANGED FROM JULY 1, 2005, TO DATES OF SERVICE BEGINNING AUGUST 1, 2005. CLAIMS WITH DATES OF SERVICE THROUGH JULY 31, 2005 WILL BE PROCESSED UNDER THE "LIST" METHODOLOGY. PROVIDERS ARE ASKED TO HOLD CLAIMS FOR APRN SERVICES WITH DATES OF SERVICE AUGUST 1, 2005 FORWARD UNTIL NOTIFIED BY THE DEPARTMENT. IT IS ANTICIPATED THAT THE SYSTEM CHANGES WILL BE IN PLACE WITHIN THE NEXT SEVERAL WEEKS. PLEASE MONITOR FUTURE RA MESSAGES WHICH WILL INFORM PROVIDERS WHEN THESE CLAIMS MAY BE SUBMITTED.