RA Messages for August 21, 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 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.
ATTENTION PHARMACY PROVIDERS
UPDATES TO THE PHARMACY BENEFITS
MANAGEMENT SERVICES MANUAL ARE NOW AVAILABLE ON THE LOUISIANA MEDICAID
WEBSITE AT WWW.LAMEDICAID.COM. PHARMACY PROVIDERS SHOULD REFER TO THE
MANUAL FOR A COMPLETE DESCRIPTION OF MEDICAID PHARMACY PROGRAM POLICY.
ATTENTION ALL PROVIDERS
THE SCHEDULED DATES AND LOCATIONS FOR
2007 FALL PROVIDER WORKSHOPS FOLLOWS. THE DETAILED TRAINING SCHEDULE
WILL BE AVAILABLE ON THE LAMEDICAID WEB SITE, WWW.LAMEDICAID.COM,
TRAINING LINK THIS WEEK. PLEASE REVIEW THE COMPLETE SCHEDULE FOR THE
DAYS/DATES OF THESE WORKSHOPS:
BATON ROUGE - SEPTEMBER 11TH, 12TH, 13TH; LAFAYETTE - SEPTEMBER 17TH,
18TH, 19TH; LAKE CHARLES - SEPTEMBER 20TH; SHREVEPORT/BOSSIER -
SEPTEMBER 25TH, 26TH, 27TH; AND NEW ORLEANS - OCTOBER 2ND, 3RD, 4TH.
COMMUNITYCARE NOTICE TO ALL
MEDICAID PROVIDERS
DUE TO THE EFFECTS OF HURRICANES
KATRINA AND RITA, DHH SUSPENDED MANDATORY COMMUNITYCARE LINKAGES IN SOME
OF THE MOST HEAVILY AFFECTED AREAS. EFFECTIVE OCTOBER 1, 2007, DHH WILL
RESUME MANDATORY LINKAGES IN ORLEANS (36) AND CAMERON (12) PARISHES.
COMMUNITYCARE PCPS IN THESE PARISHES SHOULD NOTICE AN INCREASE IN THE
NUMBER OF COMMUNITYCARE LINKAGES ON THEIR CP-0-92 REPORT BEGINNING
OCTOBER 2007. ALL PROVIDERS SHOULD BE AWARE THAT MEDICAID PATIENTS WHOM
THEY HAVE BEEN TREATING MAY BECOME LINKED TO A COMMUNITYCARE PCP
EFFECTIVE OCTOBER 1, 2007. IN ORDER TO BE REIMBURSED BY MEDICAID,
PROVIDERS WHO ARE NOT THE PCP OF RECORD MUST HAVE A
REFERRAL/AUTHORIZATION FROM THE APPROPRIATE PCP (AS REFLECTED ON THE
MEDICAID ELIGIBILITY VERIFICATION SYSTEM) PRIOR TO PROVIDING SERVICES.
IT IS THE MEDICAID PROVIDER'S RESPONSIBILITY TO VERIFY RECIPIENT
ELIGIBILITY/COMMUNITYCARE.
ATTENTION ALL PROVIDERS
LA MEDICAID RECIPIENTS MAY NOT BE
BILLED FOR SERVICES BECAUSE OF CLAIM DENIALS DUE TO BILLING ERRORS OR
THE FAILURE OF THE PROVIDER TO TAKE THE NECESSARY STEPS TO FOLLOW
THROUGH ON DENIALS IN ORDER TO GET CLAIMS PAID. DHH IS RECEIVING A
SIGNIFICANT NUMBER OF RECIPIENT CALLS WHERE THE RECIPIENT IS RECEIVING A
BILL FOR SERVICES AND RESEARCH INDICATES THAT THE CLAIMS WERE DENIED DUE
TO BILLING ERRORS OR FAILURE OF PROVIDERS TO
FOLLOW-UP ON RESOLVING CLAIM DENIALS TIMELY. ACCORDING TO THE STANDARDS
OF PARTICIPATION AGREEMENT, RECIPIENTS MAY BE BILLED FOR SERVICES THAT
ARE NON-COVERED; EXCEED A LIMITATION SET BY THE MEDICAID PROGRAM; OR ARE
RENDERED PRIOR TO/AFTER ELIGIBILITY HAS ENDED. (SERVICES ARE CONSIDERED
NON-COVERED ONLY IF THEY ARE NOT INCLUDED IN ANOTHER COVERED SERVICE OR
IF ANOTHER COVERED MEANS OF PROVIDING THE SERVICE IS NOT AVAILABLE.)
PROVIDERS SHOULD DISCONTINUE THE PRACTICE OF SENDING BILLS TO RECIPIENTS
EXCEPT IN APPROPRIATE CIRCUMSTANCES.
ATTENTION ALL PROVIDERS
RECENTLY, UNISYS HAS EXPERIENCED AN
INCREASE IN CALLS FROM RECIPIENTS WHO HAVE INDICATED THAT A PROVIDER
SUPPLIED THEIR PROVIDER NUMBER, ALONG WITH THE UNISYS PROVIDER RELATIONS
PHONE NUMBER, IN ORDER FOR THE RECIPIENT TO CONTACT SOMEONE ABOUT A
CLAIM DENIAL. WE WANT TO REMIND PROVIDERS THAT CLAIM DENIALS ARE TO BE
HANDLED BY THE PROVIDER, NOT THE RECIPIENT, AND UNISYS PROVIDER
RELATIONS PHONE LINES ARE FOR PROVIDER USE. ADDITIONALLY, WE WANT TO
ALERT PROVIDERS THAT GIVING PROVIDER ID
NUMBERS TO RECIPIENTS IS HIGHLY DISCOURAGED. PLEASE ENSURE THAT YOUR
OFFICE STAFF IS NOT ENGAGING IN THIS PRACTICE.