RA Messages for August 2, 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
LINDANE LOTION1%
TEMAZEPAM CAPSULE 7.5MG

PLEASE MAKE SURE THE FOLLOWING CHANGES TO APPENDIX C:

LABELER COMPANY BEGIN END
68817 AMERICAN PHARMACEUTICAL PARTNERS 07/01/05  
67817 ONCOLOGY THERAPEUTICS NETWORK 10/01/05  
68382 ZYDUS PHARMACEUTICAL (USA) INC 10/01/05  

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 ANESTHESIA PROVIDERS

THE DEPARTMENT IS AWARE THAT SOME ANESTHESIA CLAIMS UTILIZING THE FORMULA METHODOLOGY ARE REIMBURSING INCORRECTLY. PROVIDERS WILL BE NOTIFIED WHEN THE PROGRAMMING HAS BEEN CORRECTED AND CLAIMS HAVE BEEN ADJUSTED. 

ATTENTION IMMUNIZATION PROVIDERS

IMMUNIZATION CLAIMS THAT HAVE IMPROPERLY DENIED WITH ERROR EDITS 233 (PROCEDURE NNON-COVERED FOR SERVICE DATES) OR 675(VACCINE/ADMINISTRATION
CONFLICT) WILL BE RECYCLED AND SHOULD APPEAR ON THE REMITTANCE ADVICE 
OF JULY 19, 2005. 

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2004, THE FOLLOWING CPT CODES WERE ADDED TO THE LIST OF CODES PAYABLE TO CLINICAL NURSE SPECIALIST, CERTIFIED NURSE PRACTITIONER, AND NURSE MIDWIFE. 

17250 AND 94650 

ATTENTION ALL ELECTRONIC CLAIM SUBMITTERS

ONCE THE NEW ANNUAL CERTIFICATION FORM IS ON FILE FOR 2005, INDIVIDUAL CERTIFICATION FORMS FOR EACH FILE TRANSMISSION ARE NO LONGER REQUIRED. ALSO, REMEMBER THAT THE CERTIFICATION FORM IS REQUIRED FOR EACH SUBMITTER NUMBER AND IS NOT REQUIRED FROM PROVIDERS THAT SUBMIT ELECTRONIC CLAIMS THROUGH A THIRD PARTY BILLING AGENT.

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.