RA Messages for September 12, 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:  

GABAPENTIN CAPSULES, 100MG;300MG;400MG; TABLETS, 600MG;800MG         MEPROBAMATE TABLETS, 400MG                                          
OFLOXACIN OTIC DROPS, 0.3%                                          
THEOPHYLLINE ANHYDROUS ELIXIR, 80MG/15ML                            

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

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.                              

 

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ATTENTION ALL PROVIDERS: 2005 FALL PROVIDER TRAINING HAS BEEN CANCELLED 
STATEWIDE DUE TO HURRICANE KATRINA. PLEASE REFER TO UPCOMING REMITTANCE 
ADVICE MESSAGES, PROVIDER UPDATE ARTICLES AND LA MEDICAID WEBSITE 
(WWW.LAMEDICAID.COM) FOR RESCHEDULING INFORMATION. 

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ATTENTION ALL PROVIDERS: EFFECTIVE WITH DATE OF SERVICE AUGUST 27, 2005,
THE COMMUNITYCARE AND KIDMED LINKAGE EDITS WILL BE BY-PASSED FOR 
RECIPIENTS RESIDING IN THE FOLLOWING PARISHES: ORLEANS, JEFFERSON, ST. 
BERNARD, ST. TAMMANY, ST. CHARLES, ST. JOHN, ST. JAMES, LAFOURCHE, 
TERREBONNE, TANGIPAHOA, PLAQUEMINES, AND WASHINGTON. THIS MEANS THAT YOU DO NOT NEED A PCP REFERRAL TO PROVIDER SERVICES TO RECIPIENTS FROM THESE PARISHES. UNTIL FURTHER NOTICE, DHH IS ALSO BY-PASSING THE 60-DAY TIMELY FILING EDIT FOR KIDMED CLAIMS ONLY, FOR ALL PROVIDERS STATEWIDE. 

ATTENTION ANESTHESIA PROVIDERS

EFFECTIVE JULY 1, 2004, FORWARD, LOUISIANA MEDICAID HAS PLACED CPT CODE 00952 (ANESTHESIA FOR VAGINAL PROCEDURES; HYSTEROSCOPY AND/OR HYSTEROSALPINGOGRAPHY) IN PAY STATUS. THE CLAIMS WILL PEND TO MEDICAL REVIEW AND MUST BE SUBMITTED HARDCOPY WITH THE ANESTHESIA RECORD ATTACHED. IF CPT CODE 00952 IS BILLED FOR ANESTHESIA ADMINISTERED DURING A HYSTEROSALPINGOGRAM (HSG), THE HSG MUST MEET MEDICAID REQUIREMENTS FOR ANESTHESIA TO BE PAID. 

ATTENTION PROFESSIONAL SERVICES PROVIDERS

EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2005, FORWARD, LOUISIANA MEDICAID HAS PLACED CPT CODE 58340 (CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRACT FOR HYSTEROSALPINGOGRAPHY) IN PAY STATUS. CLAIMS MUST BE SUBMITTED HARDCOPY WITH ATTACHMENTS AND WILL PEND TO MEDICAL REVIEW. ATTACHMENTS MUST INCLUDE THE PURPOSE FOR AND RADIOLOGICAL INTERPRETATION OF THE PROCEDURE. REIMBURSEMENT FOR THIS PROCEDURE IS LIMITED TO THE ASSESSMENT OF FALLOPIAN TUBE OCCLUSION OR LIGATION FOLLOWING A STERILIZATION PROCEDURE. LOUISIANA MEDICAID WILL NOT REIMBURSE FOR THE DIAGNOSIS AND/OR TREATMENT OF INFERTILITY. 

ATTENTION PROFESSIONAL SERVICES PROVIDERS

EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2005, FORWARD, LOUISIANA MEDICAID HAS PLACED CPT CODE 58565 (HYSTEROSCOPY, SURGICAL; WITH FALLOPIAN TUBE CANNULATION TO INDUCE OCCLUSION BY PLACEMENT OF PERMANENT IMPLANTS) IN PAY STATUS. WHEN THE PROCEDURE IS PERFORMED IN THE PHYSICIAN'S OFFICE, REIMBURSEMENT INCLUDES THE COST OF THE DEVICE. WHEN THE PROCEDURE IS PERFORMED OUTSIDE OF THE OFFICE, THE PHYSICIAN REIMBURSEMENT RATE DOES NOT INCLUDE THE COST OF THE DEVICE.

EXPANDED COVERAGE OF CHEMOTHERAPY

EFFECTIVE WITH DATE OF SERVICE 9-1-05 FORWARD, MEDICAID'S PROFESSIONAL SERVICE PROGRAM HAS MADE MOST CHEMOTHERAPY AND SUPPORTIVE CARE DRUGS PAYABLE AT THE CURRENT RATE TO FACILITATE EXPANDED ACCESS TO CHEMOTHERAPY SERVICES DURING THE RECOVERY FROM HURRICANE KATRINA. THESE MEDICATIONS ARE NOW REIMBURSABLE WHEN PROVIDED IN THE OFFICE SETTING IN ADDITION TO THE PREVIOUS PLACES OF SERVICE.

NOTICE TO DENTAL PROVIDERS - DENTAL PA TEMPORARILY DISCONTINUED

DUE TO HURRICANE KATRINA, MEDICAID IA DISCONTINUING THE DENTAL PRIOR AUTHORIZATION REQUIREMENT FOR THE EPSDT DENTAL, ADULT DENTURE, AND EXPANDED DENTAL SERVICES FOR PREGNANT WOMEN PROGRAMS FOR DATES OF SERVICE FROM AUGUST 29, 2005 THROUGH SEPTEMBER 20, 2005. PLEASE REFER TO THE FOLLOWING WEBSITE FOR ADDITIONAL AND UPDATED INFORMATION: WWW.LAMEDICAID.COM. IF YOU HAVE ANY QUESTIONS, YOU AY CALL TERRI NORWOOD, DENTAL PROGRAM SPECIALIST AT (225) 342-9403.