RA Messages for September 11, 2007

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IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT THE PBM HELP DESK AT 1-800-648-0790.

PLEASE NOTE THE FOLLOWING CHANGES TO APPENDIX C:

 

LABELER         COMPANY                                                                                  BEGIN                                      END

 

30698                 VALIDUS PHARMACEUTICALS INC                                       10/01/07

31357                 INSPIRE PHARMACEUTICALS INC                                         10/01/07

59743                 ALPHAGEN LABORATORIES INC                                                                                             10/01/07

64803                 OXFORD PHARMACEUTICALS SERVICES                             10/01/07

65086                 SANTEN INCORPORATED                                                                                                         10/01/07

66346                 PEDIAMED PHARMACEUTICALS INC                                                                                     10/01/07

67979                 INDEVUS PHARMACEUTICALS INC                                      10/01/07

68134                 LASER PHARMACEUTICALS LLC                                                                                             10/01/07

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.

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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).

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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.

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ATTENTION PHARMACISTS AND PRESCRIBING PROVIDERS

USE OF TAMPER-RESISTANT PRESCRIPTION PADS

A PROVISION IN THE U.S. TROOP READINESS, VETERANS' HEALTH CARE, KATRINA RECOVERY AND IRAQ ACCOUNTABILITY APPROPRIATIONS ACT OF 2007 (H.R. 2206), SECTION 7002(B) REQUIRES THE USE OF TAMPER-RESISTANT PRESCRIPTION DRUG PADS FOR WRITTEN, NON-ELECTRONIC PRESCRIPTIONS FOR MEDICAID RECIPIENTS.  THIS PROVISION IS EFFECTIVE 10-1-07.  IN AN EFFORT TO REDUCE INSTANCES OF UNAUTHORIZED, IMPROPERLY ALTERED AND COUNTERFEIT PRESCRIPTIONS, ALL WRITTEN PRESCRIPTIONS REIMBURSED BY LOUISIANA MEDICAID ARE SUBJECT TO THIS STATUTORY REQUIREMENT.  PLEASE REFER TO WWW.LAMEDICAID.COM FOR ADDITIONAL INFORMATION ON POLICY REGARDING TAMPER-RESISTANT PRESCRIPTION PADS.

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ATTENTION DENTAL PROVIDERS

ERROR CODE 515 CLAIM DENIAL SIMPLIFICATION PROCESS

PROVIDERS SHOULD OBTAIN DETAILED INFORMATION AT WWW.LAMEDICAID.COM UNDER THE LINK ENTITLED "NEW MEDICAID INFORMATION." IF YOU HAVE QUESTIONS, CONTACT THE MEDICAID DENTAL UNIT BY CALLING 225-216-6470.

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COMMUNITYCARE NOTICE TO ALL MEDICAID PROVIDERS

EFFECTIVE NOVEMBER 5, 2007, THE UB92 FORM WILL BE DISCONTINUED AND ONLY THE UB04 FORM WILL BE ACCEPTED. WHEN USING THE UB04 OR 837I FOR CLAIMS WHICH REQUIRE A COMMUNITYCARE PCP REFERRAL/AUTHORIZATION, THE REFERRAL/ AUTHORIZATION NUMBER MUST NOW BE PLACED IN LOCATOR 63C INSTEAD OF 83A. PLACING THE REFERRAL/AUTHORIZATION NUMBER IN ANY OTHER LOCATION WILL CAUSE THE CLAIM TO DENY. QUESTIONS REGARDING THE NEW UB04 FORM SHOULD BE DIRECTED TO UNISYS PROVIDER RELATIONS AT (800)473-2783.

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ATTENTION PROVIDERS

THE DEPARTMENT OF HEALTH AND HOSPITALS BUREAU OF HEALTH SERVICES FINANCING IN CONJUNCTION WITH THE OFFICE FOR CITIZENS WITH DEVELOPMENTAL DISABILITIES AND THE OFFICE OF AGING AND ADULT SERVICES IS REQUIRING MANDATORY ATTENDANCE FOR ALL DIRECT SERVICE PROVIDERS (SPECIFICALLY PERSONAL CARE SERVICE PROVIDERS, PERSONAL CARE ATTENDANTS AND SUPERVISED INDEPENDENT LIVING PROVIDERS) TO WORKSHOP SESSIONS ON WAIVER, PROGRAM INTEGRITY AND PERSONAL CARE SERVICES (WORKSHOP SESSIONS: 10:30-11:45 WAIVER AND CASE MANAGEMENT, 1:00-1:45 PROGRAM INTEGRITY AND 2:00-3:30 PCS). PROVIDERS MUST SIGN IN AND ATTEND THESE SESSIONS AT THE MANDATORY SITE ASSIGNMENT FOUND ON THE LAMEDICAID HOME PAGE. CLICK ON MANDATORY PROVIDER TRAINING FOR DIRECT CARE WORKERS. THIS INFO WAS ALSO DISTRIBUTED TO YOU VIA FAX OR MAIL.

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ATTENTION PROVIDERS

EFFECTIVE OCTOBER 1, 2007, DIRECT CARE PROVIDERS (WITH THE EXCEPTION OF SUPPORT COORDINATION AGENCIES AND PERSONAL EMERGENCY RESPONSE PROVIDERS) WILL NO LONGER BE ALLOWED TO SPAN DATE BILL. FOR DATES OF SERVICE ON OR AFTER THAT DATE, WHEN CLAIMS ARE SUBMITTED ON THE CMS 1500 OR VIA ELECTRONIC MEDIA, PROVIDERS WILL HAVE TO LINE-ITEM CLAIMS, INDICATING A SINGLE DATE OF SERVICE AND THE NUMBER OF UNITS PROVIDED ON THAT PARTICULAR DAY.