RA Messages for August 30, 2005
PHARMACY PROVIDERS, PLEASE NOTE!!!
PLEASE MAKE THE FOLLOWING CHANGES TO THE APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 00043 |
NOVARTIS
CONSUMER HEALTH INC |
|
10/01/05 |
| 10135 |
MARLEX
PHARMACEUTICALS INC |
|
10/01/05 |
| 10144 |
ACCORDA
THERAPEUTICS, INC |
10/01/05 |
|
| 10631 |
RANBAXY
LABORATORIES INC |
10/01/05 |
|
| 10922 |
INTENDIS
INC |
10/01/05 |
|
| 12948 |
NITROMED
INC |
10/01/05 |
|
| 13107 |
AUROBINDO
PHARMA USA, INC |
07/01/05 |
|
| 13279 |
ALLAN
PHARMACEUTICAL LLC |
10/01/05 |
|
| 13533 |
TALECRIS
BIOTHERAPEUTICS INC |
10/01/05 |
|
| 13913 |
DEPOMED
INC |
10/01/05 |
|
| 58552 |
GIL
PHARMACEUTICAL CORP |
|
10/01/05 |
| 53265 |
ABLE
LABORATORIES, INC |
|
07/01/05 |
| 59291 |
IYATA
PHARMACEUTICALS INC |
|
10/01/05 |
| 59441 |
SHIRE
US INC |
|
10/01/05 |
| 65430 |
DEX
GEN PHARMACEUTICAL INC |
|
07/01/05 |
| 65939 |
LIFECYCLE
VENTURES INC |
|
10/01/05 |
| 66780 |
AMYLIN
PHARMACEUTICALS, INC |
10/01/05 |
|
| 68158 |
PRAECIS
PHARMACEUTICALS 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
SCHEDULE
II NARCOTIC ANALGESICS
PREVIOUSLY,
PRESCRIPTIONS FOR SCHEDULE II NARCOTIC ANALGESICS HAD TO BE FILLED
WITHIN 5 DAYS OF THE DATE OF THE PRESCRIPTION. THIS POLICY, HOWEVER, HAS BEEN
REVISED, EFFECTIVE WITH DATE OF SERVICE AUGUST 20,2005. THE NEW POLICY STATES
THAT PRESCRIPTIONS FOR SCHEDULE II NARCOTIC
ANALGESICS
SHALL BE FILLED WITHIN 6 MONTHS OF THE DAY THE PRESCRIPTION WAS WRITTEN. A
DENIAL ERROR CODE OF #454 (NEW PRESCRIPTION NOT FILLED
WITHIN 6
MONTHS OF THE DATE PRESCRIBED), WHICH IS CROSS-REFERENCED TO
NCPDP CODE M4,
WILL APPLY TO THOSE PRESCRIPTIONS FILLED AFTER 6 MONTHS FROM THE DATE WRITTEN.
PRESCRIBING
PROVIDERS AND PHARMACISTS
EFFECTIVE
AUGUST 22, 2005, MEDICAID BEGAN ACCEPTING AN ICD-9 DIAGNOSIS CODE IN THE RANGE
OF 345.0-345.99 OR 780.30-780.39 TO BY-PASS THE THERAPEUTIC DUPLICATION EDIT
(482) FOR ANTI-ANXIETY AGENTS FOR RECIPIENTS
WHO HAVE
SEIZURES. THE DIAGNOSIS CODE MUST BE DOCUMENTED ON THE HARDCOPY PRESCRIPTION
AFTER WRITTEN OR VERBAL CONSULTATION WITH THE PRESCRIBER. MEDICAID ALSO ACCEPTS
AN ICD-9 DIAGNOSIS CODE OF 781.0 TO
PROCESS
CLAIMS FOR ANTIPSYCHOTIC AGENTS.
CERTIFIED NURSE PRACTITIONER, CLINICAL NURSE
SPECIALIST
AND CERTIFIED NURSE MIDWIFE UPDATE
THE EFFECTIVE DATE OF IMPLEMENTATION OF THE CHANGES IN REIMBURSEMENT METHODOLOGY FROM A "LIST" OF BILLABLE SERVICES TO COVERED SERVICES
DETERMINED BY LICENSURE AND SCOPE OF PRACTICE HAS BEEN CHANGED FROM JULY 1, 2005, TO DATES OF SERVICE BEGINNING AUGUST 1, 2005. CLAIMS WITH
DATES OF SERVICE THROUGH JULY 31, 2005 WILL BE PROCESSED UNDER THE
"LIST" METHODOLOGY. PROVIDERS ARE ASKED TO HOLD CLAIMS FOR APRN SERVICES WITH
DATES OF SERVICE AUGUST 1, 2005 FORWARD UNTIL NOTIFIED BY THE DEPARTMENT. IT IS ANTICIPATED THAT THE SYSTEM CHANGES WILL BE IN PLACE WITHIN THE
NEXT SEVERAL WEEKS. PLEASE MONITOR FUTURE RA MESSAGES WHICH WILL INFORM PROVIDERS WHEN THESE CLAIMS MAY BE SUBMITTED.
ATTENTION MENTAL HEALTH REHABILITATION PROVIDERS
THREE ISSUES HAVE BEEN IDENTIFIED WHICH HAVE CAUSED ERRONEOUS CLAIM DENIALS SINCE THE
IMPLEMENTATION OF NEW PROGRAM POLICY. 1.CERTAIN MHR PROCEDURE CODES WERE INADVERTENTLY LOADED TO BE NON-PAYABLE ON DOS 7/31/05 AND
DENIED 299.THE DATE ON THESE CODES HAS BEEN CORRECTED TO MAKE THEM NON-PAYABLE WITH AN
EFFECTIVE DOS 8/1/05. 2. PROCEDURE CODE H2015-WHEN BILLED WITH AND WITHOUT A
MODIFIER, ONE CLAIM PAID AND THE SECOND CLAIM DENIED AS A DUPLICATE WITH EDIT 813. 3.PROCEDURE CODE H0004 BILLED WITH MODIFIERS HR OR HS
DENIED 092. THESE ISSUES HAVE BEEN CORRECTED AND ALL CLAIMS DENIALS INVOLVED WILL BE RECYCLED ON THE 8/23/05 RA.
ATTENTION HOSPITALS - TRADE AREAS
OUR NEW TRADE AREA POLICY HAS BEEN IMPLEMENTED EFFECTIVE FOR DATES OF SERVICE
ON OR AFTER JULY 1, 2005. ALL ACUTE CARE OUT-OF-STATE PROVIDERS WERE
NOTIFIED OF THESE IMPENDING CHANGES IN JANUARY 2005. DUE TO PROGRAMMING
PROBLEMS, IMPLEMENTATION WAS DELAYED. THE TRADE AREA NOW CONSISTS OF ONLY THOSE
COUNTIES LOCATED IN TEXAS, ARKANSAS, & MISSISSIPPI WHICH BORDER LOUISIANA.
ALL ACUTE CARE PROVIDERS IN THESE STATES WHICH ARE NOT LOCATED IN COUNTIES THAT
BORDER LOUISIANA ARE REQUIRED TO OBTAIN PRIOR AUTHORIZATION FOR ANY INPATIENT
STAY OR OUTPATIENT SERVICE UNLESS IT IS OF AN EMERGENCY NATURE.
ATTENTION HOSPITALS - OUTPATIENT OPERATING ROOM SERVICES
IT HAS COME TO OUR ATTENTION THAT HOSPITALS ARE BILLING OUTPATIENT SURGERIES
UTILIZING REVENUE CODES 360, 361, AND 369. THIS IS INAPPROPRIATE BILLING.
EFFECTIVE FOR DATES OF SERVICE ON OR AFTER 8/5/2005, OUTPATIENT CLAIMS BILLED
USING THESE REVENUE CODES WILL DENY. OUTPATIENT SURGERIES SHOULD BE BILLED USING
THE APPROPRIATE AMBULATORY SURGERY CODE.