RA Messages for August 7, 2001
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.
ATTENTION PHARMACY PROVIDERS
THE DEPARTMENT, THROUGH AN EMERGENCY RULE, WILL CHANGE ESTIMATED ACQUISITION
COST REIMBURSEMENT FOR PRESCRIPTION DRUGS TO :
* AVERAGE WHOLESALE PRICE MINUS 13.5% FOR INDEPENDENT
PHARMACIES AND AVERAGE WHOLESALE PRICE
MINUS 15% FOR CHAIN PHARMACIES FOR ALL
SINGLE SOURCE DRUGS (BRAND NAME), MULTIPLE SOURCE DRUGS WHICH DO
NOT HAVE A STATE MAXIMUM ALLOWABLE COST OR FEDERAL UPPER LIMIT AND THOSE PRESCRIPTIONS WHICH ARE SUBJECT TO MAC OVERRIDES BASED ON
THE PHYSICIAN'S CERTIFICATION THAT A BRAND NAME PRODUCT IS MEDICALLY
NECESSARY FOR A PARTICULAR RECIPIENT. THIS REIMBURSEMENT
CHANGE IS EFFECTIVE FOR SERVICES BEGINNING AUGUST 6,2001. CHAIN
PHARMACIES ARE DEFINED AS MORE THAN FIFTEEN MEDICAID ENROLLED
PHARMACIES UNDER COMMON OWNERSHIP. ALL OTHER MEDICAID ENROLLED
PHARMACIES ARE DEFINED AS INDEPENDENT PHARMACIES.
EFFECTIVE FOR DATES OF SERVICE BEGINNING AUGUST 6, 2001, LOUISIANA MEDICAID
WILL LIMIT PAYMENTS FOR PRESCRIPTION DRUGS TO THE LOWER OF:
* ESTIMATED ACQUISITION COST WHICH IS DEFINED AS
AVERAGE WHOLESALE PRICE MINUS 13.5% FOR
INDEPENDENT PHARMACIES AND AVERAGE WHOLESALE PRICE MINUS 15% FOR CHAIN
PHARMACIES FOR ALL SINGLE SOURCE DRUGS (BRAND
NAME), MULTIPLE SOURCE DRUGS WHICH DO NOT HAVE A STATE MAXIMUM ALLOWABLE COST OR
FEDERAL UPPER LIMIT AND THOSE PRESCRIPTIONS
WHICH ARE SUBJECT TO MAC OVERRIDES BASED ON THE PHYSICIAN'S CERTIFICATION THAT A
BRAND NAME PRODUCT IS MEDICALLY NECESSARY FOR A
PARTICULAR RECIPIENT PLUS THE MAXIMUM ALLOWABLE OVERHEAD COST
(DISPENSING FEE):
* LOUISIANA MAXIMUM ALLOWABLE COST LIMITATION PLUS THE
MAXIMUM ALLOWABLE OVERHEAD COST; OR
FEDERAL UPPER LIMITS PLUS THE MAXIMUM ALLOWABLE
OVERHEAD COST; OR
* PROVIDER'S USUAL AND CUSTOMARY CHARGE TO THE GENERAL PUBLIC.
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.
CORRECTED 2001 TRAINING SESSIONS
PROVIDER TRAINING SESSIONS WILL BE HELD ON THE FOLLOWING DATES:
BATON ROUGE - SEPT. 11 AND 13 (NOTE THIS IS A TUESDAY AND THURSDAY)
COVINGTON - SEPT. 14
HOUMA - SEPT. 19 (WEDNESDAY)
NEW ORLEANS - SEPT. 20 AND 21 (THURSDAY AND FRIDAY)
ALEXANDRIA - SEPT. 26 AND 27 (WEDNESDAY AND THURSDAY)
MONROE - OCT. 1 AND 2 (MONDAY AND TUESDAY)
BOSSIER CITY - OCT. 3 AND 4 (WEDNESDAY AND THURSDAY)
LAFAYETTE - OCT. 8 AND 9 (MONDAY AND TUESDAY)
LAKE CHARLES - OCT. 10 AND 11 (WEDNESDAY AND THURSDAY)
WATCH FOR A COMPLETE SCHEDULE OF LOCATIONS AND DATES IN THE AUGUST
EDITION OF THE PROVIDER UPDATE.
NOTICE TO ALL PROVIDERS
THE DEPARTMENT OF HEALTH AND HOSPITALS HAS BEGUN EXPANDING THE COMMUNITYCARE PROGRAM TO INCLUDE ALL PARISHES THROUGHOUT THE STATE. THE FIRST NEW
PARISHES TO BE BROUGHT INTO THE PROGRAM WILL BE CALCASIEU(LAKE CHARLES) AND THE HOUMA/THIBODAUX REGION(ASSUMPTION, LAFOURCHE, ST. JAMES, ST.
JOHN THE BAPTIST, ST. MARY, AND TERREBONNE PARISHES). ALL ELIGIBLE RECIPIENTS IN CALCASIEU PARISH WILL BE ENROLLED IN COMMUNITYCARE
EFFECTIVE AUGUST 1, 2001. MEDICAID RECIPIENTS IN OTHER PARISHES THROUGHOUT THE STATE WILL BE BROUGHT INTO THE PROGRAM BEGINNING NOVEMBER 2001 THROUGH THE NEXT YEAR. RECIPIENTS WILL BE GIVEN THE OPPORTUNITY TO CHOOSE A DOCTOR FROM THOSE CLINICS AND DOCTORS WHO HAVE ENROLLED AS PRIMARY CARE PHYSICIANS IN THE
COMMUNITYCARE PROGRAM. RECIPIENTS WHO DO NOT CHOOSE A DOCTOR WILL BE ASSIGNED TO A PRIMARY CARE PHYSICIAN. COMMUNITYCARE RECIPIENTS MUST RECEIVE MOST MEDICAL CARE FROM THEIR ASSIGNED COMMUNITYCARE DOCTOR. OTHER DOCTORS OR HEALTH CARE PROVIDERS, SUCH AS HOSPITALS, MUST HAVE A
REFERRAL FROM THE COMMUNITYCARE PCP IN ORDER TO BE PAID BY MEDICAID FOR SERVICES PROVIDED TO A COMMUNITYCARE RECIPIENT.
PROVIDERS WHO ARE ELIGIBLE TO ENROLL IN THE COMMUNITYCARE PROGRAM INCLUDE PHYSICIANS, PHYSICIAN GROUPS OR CLINICS, RURAL HEALTH CLINICS, AND FEDERALLY QUALIFIED HEALTH CLINICS. ANY PHYSICIAN OR CLINIC WISHING TO HAVE MORE INFORMATION ABOUT THE PROGRAM OR TO BEGIN ENROLLMENT IN THE
PROGRAM, SHOULD CONTACT UNISYS PROVIDER RELATIONS AT 800-473-2783.
ALL PROVIDERS
EFFECTIVE SEPT. 1, 2001,PROVIDER ENROLLMENT WILL NO LONGER ACCEPT IRS FORM W-9 TO UPDATE EMPLOYER IDENTIFICATION NUMBERS (EIN) ON THE PROVIDER
FILE FOR NEW APPLICATIONS OR FILE UPDATES.IT WILL BE NECESSARY TO SUBMIT A PRE-PRINTED IRS DOCUMENT(LETTER,PAYMENT COUPON, ETC.) THAT IDENTIFIES YOUR EIN OR SSN. ALL REQUESTS RECEIVED AFTER SEPT. 1, 2001 WITH A W-9 AS
THE ONLY DOCUMENTATION FOR EIN WILL BE REJECTED FOR A PRE-PRINTED FORM. ALSO, REMEMBER THAT THE "PAY TO" NAME ON THE PE-50 MUST MATCH THE NAME
ON THE IRS FORM EXACTLY!
NOTICE TO ANESTHESIOLOGISTS AND CRNAS
EFFECTIVE WITH DATE OF SERVICE AUGUST 1, 2001, CPT CODE 46924
(DESTRUCTION OF LESION(S), ANUS (EG., CONDYLOMA, PAPILLOMA, MOLLUSCUM,
CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE, ANY METHOD) WILL BE FUNDED WITH 5 BASE UNITS OF ANESTHESIA.