RA Messages for August 28, 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 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.

DHH WANTS YOUR NPI

IF YOU HAVE NOT REGISTERED YOUR NATIONAL PROVIDER IDENTIFIER (NPI) WITH UNISYS, PLEASE DO SO IMMEDIATELY. THE NPI WEB REGISTRATION SITE IS ACCESSIBLE FROM THE LIST OF APPLICATIONS IN THE SECURED PROVIDER AREA OF THE WWW.LAMEDICAID.COM WEBSITE. PROVIDERS MAY CHOOSE TO REGISTER THEIR NPI USING THE NPI PAPER REGISTRATION FORM LOCATED FROM WWW.LAMEDICAID. COM>HIPAA INFORMATION CENTER>NATIONAL PROVIDER IDENTIFIER (NPI).

ATTENTION PROFESSIONAL SERVICES PROVIDERS

\DHH IS PLEASED TO ANNOUNCE THAT EFFECTIVE WITH DATE OF SERVICE 7-1-2006 FORWARD, LOUISIANA MEDICAID REIMBURSES PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT SERVICES FOR ADULTS, AGED 21 YEARS AND OLDER. PROVIDERS ARE TO USE THE APPROPRIATE PREVENTIVE MEDICINE CPT CODE BASED ON THE AGE OF THE RECIPIENT WHEN SUBMITTING CLAIMS FOR THESE SERVICES. ONE PREVENTIVE MEDICINE SERVICE WILL BE ALLOWED PER CALENDAR YEAR. THE PREVENTIVE MEDICINE SERVICES WILL BE INCLUDED IN THE 12 OUTPATIENT VISIT - SERVICE LIMIT ALLOWED PER CALENDAR YEAR. PROVIDERS ARE RESPONSIBLE FOR ADHERENCE TO THE ADULT PREVENTIVE MEDICINE SERVICES POLICY WHICH CAN BE LOCATED ON THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM USING THE APPROPRIATE LINK ON THE HOME PAGE.