RA Messages for August 24, 2004

---

PREVACID NAPRAPAC UNIT BILLING ERRORS

PLEASE NOTE THAT PREVACID NAPRAPAC IS BILLABLE TO LOUISIANA MEDICAID BY THE TABLET/CAPSULE AND MUST BE BILLED IN MULTIPLES OF 21.

---

ATTENTION PHARMACY PROVIDERS:

ACCORDING TO GUIDANCE SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) IN A STATE MEDICAID DIRECTOR'S LETTER DATED JULY 19, 2004, A MEDICAID RECIPIENT WHO HAS A MEDICARE-APPROVED DISCOUNT CARD DOES NOT HAVE TO UTILIZE THE $600 BENEFIT PRIOR TO MEDICAID REIMBURSING FOR A PHARMACY CLAIM. "..... A BENEFICIARY WITH A MEDICARE-APPROVED DRUG DISCOUNT CARD AND TRANSITIONAL ASSISTANCE WHO IS ALSO ELIGIBLE FOR MEDICAID DOES NOT HAVE TO SPEND THE $600 CREDIT BEFORE MEDICAID WILL PAY FOR THE BENEFICIARY'S PRESCRIPTION DRUGS."                                                               

CMS FURTHER STATES IN A DRUG CARD AND MEDICAID SPENDDOWN QS AND AS, "...MEDICAID BECOMES THE PRIMARY PAYOR FOR DRUGS COVERED BY MEDICAID, THE  INDIVIDUAL CAN SAVE WHATEVER REMAINS OF THE $600 CREDIT TO USE IN THE  FUTURE SHOULD HE LOSE MEDICAID BENEFITS (OR USE FOR DRUGS THAT ARE NOT COVERED BY MEDICAID)..."                                          

PLEASE DISREGARD EARLIER DIRECTIONS GIVEN BY LOUISIANA MEDICAID BENEFITS MANAGEMENT UNIT REGARDING UTILIZATION OF THE $600 CREDIT ASSOCIATED WITH THE MEDICARE-APPROVED DISCOUNT CARDS.  

---

ATTENTION PHYSICIAN AND KIDMED PROVIDERS

EFFECTIVE 8/23/04, FOR CLAIM DATES OF SERVICE BEGINNING 10/1/03 FORWARD, CLAIMS SUBMITTED USING PREVENTIVE MEDICINE PROCEDURE CODES 99381-99385 OR 99391-99395 MUST REFLECT THE CORRECT PROCEDURE CODE FOR THE AGE OF THE CHILD. CLAIM EDITS ARE BEING PLACED IN THE CLAIMS PROCESSING LOGIC THAT WILL PREVENT PAYMENT OF THESE PROCEDURE CODES IF THEY ARE NOT APPROPRIATE FOR THE AGE OF THE CHILD. PLEASE MAKE ANY NECESSARY CHANGES TO YOUR INTERNAL SYSTEMS OR PROCEDURES TO ACCOMMODATE THIS PROCESSING CHANGE. QUESTIONS MAY BE DIRECTED TO PROVIDER RELATIONS AT 800-473-2783 OR 225-924-5040. 

---

ATTENTION ALL EPSDT DENTAL PROVIDERS

EFFECTIVE SEPTEMBER, 1, 2004, THE RATES FOR CERTAIN DESIGNATED DENTAL PROCEDURES WILL BE INCREASED AND A NEW PROCEDURE FOR RETREATMENT OF PREVIOUS ROOT CANAL THERAPY, ANTERIOR (D3346) WILL BE MADE PAYABLE AS A RESULT OF THE ALLOCATION OF ADDITIONAL FUNDS BY THE LEGISLATURE DURING THE 2004 REGULAR SESSION. SPECIFIC INFORMATION REGARDING THE RATE INCREASES AND THE POLICIES ESTABLISHED FOR PROCEDURE CODE D3346 WILL BE AVAILABLE ON THE FOLLOWING WEBSITE AS SOON AS POSSIBLE: HTTP://WWW.LAMEDICAID.COM. IF YOU DO NOT HAVE INTERNET ACCESS AND NEED TO REQUEST A HARDCOPY OF THIS INFORMATION ONCE IT IS AVAILABLE, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225) 924-5040.AS A REMINDER, PROVIDERS SHOULD BILL THEIR USUAL AND CUSTOMARY FEE.

---

ATTENTION ALL EXPANDED DENTAL SERVICES 
FOR PREGNANT WOMEN (EDSPW) PROVIDERS 

EFFECTIVE SEPTEMBER 1, 2004, THE RATES FOR CERTAIN DESIGNATED DENTAL PROCEDURES WILL BE INCREASED. SPECIFIC INFORMATION REGARDING THE RATE INCREASES WILL BE AVAILABLE ON THE FOLLOWING WEBSITE AS SOON AS POSSIBLE HTTP://WWW.LAMEDICAID.COM. IF YOU DO NOT HAVE INTERNET ACCESS AND NEED TO REQUEST A HARDCOPY OF THIS INFORMATION ONCE IT IS AVAILABLE, YOU MAY CONTACT UNISYS PROVIDER RELATIONS AT (800)473-2783 OR (225) 924-5040. AS A REMINDER, PROVIDER SHOULD BILL THEIR USUAL AND CUSTOMARY FEE.