RA Messages for August 29, 2000
PHARMACY PROVIDERS
IT HAS BEEN DETERMINED THAT THE PHARMACY CLAIM ADJUSTMENTS REFLECTED
ON THE REMITTANCE ADVICE(S) FOR AUGUST 9, 2000 AND AUGUST 16, 2000 MAY CONTAIN AN INCORRECT CALCULATION. PLEASE BE ADVISED THAT YOU
WILL NOT NEED TO RESUBMIT ANY OF THESE
CLAIMS. ALL CLAIMS ADJUSTED FOR
AUGUST 9, 2000 AND AUGUST 16, 2000 WILL BE REPROCESSED THE WEEKS OF
SEPTEMBER 5, 2000 AND SEPT 12, 2000 AS DEBIT/CREDIT TRANSACTIONS. WE
APOLOGIZE
FOR ANY INCONVENIENCE RESULTING FROM THE ABOVE,
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 MAKE THE FOLLOWING CHANGES TO THE 5/15/00 VERSION OF
APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| AMYLASE/LIPASE/PROTEASE |
CAPSULE |
15-1.2-15 |
|
06/06/00 |
| AMYLASE/LIPASE/PROTEASE |
CAPSULE |
30-2.4-30 |
|
06/06/00 |
| ATORVASTATIN CALCIUM |
TABLET |
80MG |
|
06/27/00 |
| ATOVAQUONNE/PROQUANIL HCL |
TABLET |
62.5 - 25MG |
|
07/31/00 |
| ATOVAQUONNE/PROQUANIL HCL |
TABLET |
250 - 100MG |
|
07/31/00 |
| BETHANECHOL CHLORIDE |
TABLET |
10MG |
OFF MAC |
06/01/00 |
| BETHANECHOL CHLORIDE |
TABLET |
25MG |
OFF MAC |
06/01/00 |
| BETHANECHOL CHLORIDE |
TABLET |
50MG |
OFF MAC |
06/01/00 |
| BEXAROTENE |
GEL |
1% |
|
07/06/00 |
| CAFFEINE CITRATED |
VIAL |
20MG/ML |
|
11/22/99 |
| CERIVASTATIN SODIUM |
TAB |
0.8MG |
|
07/26/00 |
| DEFEROXAMINE MESYLATE |
VIAL |
2G |
|
07/10/00 |
| ETODOLAC |
TAB SR 24H |
500MG |
|
08/04/00 |
| GATIFLOXACIN/DEXT.5%-WATER PB |
200MG/100 |
|
|
06/21/00 |
| GATIFLOXACIN/DEXT.5%-WATER PB |
400MG/200 |
|
|
06/21/00 |
| GLYBURIDE/METFORMIN HCL |
TABLET |
1.25-250MG |
|
07/31/00 |
| GLYBURIDE/METFORMIN HCL |
TABLET |
2.50-500MG |
|
07/31/00 |
| GLYBURIDE/METFORMIN HCL |
TABLET |
5.00-500MG |
|
07/31/00 |
| LEVETIRACETAM |
TABLET |
750MG |
|
07/10/00 |
| MANNITOL |
IRRIG SOL |
5% |
|
11/01/96 |
| METHYLPHENIDATE HCL |
TAB SA OSM |
18MG |
|
08/16/00 |
|
PHENYLEPH TAN/PYRIL TAN |
SUSP |
|
|
08/16/00 |
| SOMATROPIN |
CARTRIDGE |
1.2MG; 1.4; 1.6; 1.8; 2MG |
|
05/01/00 |
| TRIAMINOLONE ACET. |
NASAL SPRAY |
|
|
06/19/00 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.
NOTICE TO HOSPITALS
WE HAVE RECENTLY RECEIVED A REQUEST FOR CLARIFICATION OF DISCHARGE TIME.
LOUISIANA MEDICAID ADOPTS MEDICARE'S DEFINITION OF DISCHARGE TIME WHICH IS AS
FOLLOWS.
A HOSPITAL INPATIENT IS CONSIDERED DISCHARGED FROM A HOSPITAL
PAID UNDER THE PROSPECTIVE PAYMENT SYSTEM WHEN (1) THE PATIENT IS FORMALLY
RELEASED FROM THE HOSPITAL; OR (2)THE PATIENT DIES IN THE HOSPITAL.
THE ABOVE DEFINITION APPLIES TO BOTH INPATIENT AND OUTPATIENT DISHCARGES
NON-MEDICALLY NECESSARY CIRCUMSTANCES DO NOT FACTOR IN DETERMINING THE
DISCHARGE TIME, AND LOUISIANA MEDICAID WILL NOT REIMBURSE PROVIDERS UNDER THESE
CIRCUMSTANCES (EX: PATIENT DOES NOT HAVE A RIDE HOME; PATIENT DOES NOT WANT TO
LEAVE THE FACILITY; ETC.).
IF AND WHEN NON-MEDICALLY NECESSARY CIRCUMSTANCES ARISE AND A RECIPIENT DOES NOT
LEAVE THE HOSPITAL WHEN HE IS DISCHARGED, THE HOSPITAL MAY BILL THE RECIPIENT
FOR THESE CHANGES, BUT ONLY AFTER HOSPITAL PERSONNEL INFORM THE PATIENT THAT
LOUISIANA MEDICAID WILL NOT COVER THIS PORTION OF THE STAY.