PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX C:

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 PROFESSIONAL SERVICES PROVIDERS

LOUISIANA MEDICAID DOES NOT PAY FOR SERVICES PROVIDED RELATED TO A NON-COVERED SERVICE. AN EXAMPLE OF THIS INAPPROPRIATE BILLING SITUATION WOULD BE BILLING FOR LOCAL ANESTHESIA PROVIDED DURING A ROUTINE CIRCUMCISION OF A NEWBORN. NEITHER OF THESE SERVICES, IN THIS INSTANCE, IS REIMBURSABLE IN THE LOUISIANA MEDICAID PROGRAM. PAYMENTS RECEIVED FOR NON-COVERED AND RELATED SERVICES ARE SUBJECT TO RECOUPMENT.

ATTENTION DENTAL PROVIDERS

IN THE NEAR FUTURE, MEDICAID WILL RECYCLE DENTAL CLAIMS THAT ERRONEOUSLY DENIED FOR EXCEEDING SERVICE LIMITS WITH ERROR CODES 605, 741, & 901 FOR DATES OF SERVICE 1/5/2006 THROUGH 7/26/2006. MEDICAID WILL ALSO RECYCLE RHC/FQHC DENTAL PROVIDER ENCOUNTER CLAIMS FOR THESE DATES OF SERVICE THAT ERRONEOUSLY DENIED WITH ERROR CODE 136 DUE TO AN INCORRECT SERVICE LIMIT DENIAL OF A DETAIL CLAIM LINE. THE RECYCLED CLAIMS WILL APPEAR ON YOUR RA. IF YOU HAVE ANY QUESTIONS, YOU MAY CONTACT UNISYS PROVIDER RELATIONS BY CALLING (800)473-2783 OR (225)924-5040. 

ATTENTION OUT-OF-STATE HOSPITAL PROVIDERS
OUTPATIENT EMERGENCY ROOM CLAIMS

OUT-OF-STATE HOSPITALS THAT PROVIDED OUTPATIENT EMERGENCY SERVICES TO LOUISIANA MEDICAID HURRICANE KATRINA EVACUEES HAVE RECEIVED NUMEROUS DENIALS ON OUTPATIENT CLAIMS. THIS CLAIMS WITH AN EMERGENCY ROOM (ER) CHARGE WHICH RECEIVED A DENIAL CODE OF 532: OUT-OF-STATE SERVICE REQUIRES DHH APPROVAL LETTER, ARE BEING REPROCESSED. PROVIDERS WHO HAVE QUESTIONS REGARDING ER CLAIMS WHICH HAVE DENIED WITH OTHER ERROR CODES, INCLUDING ERROR CODE 106: BILLING PROVIDER NOT PCP OR SERVICE NOT AUTHORIZED BY PCP, SHOULD CONTACT PROVIDER RELATIONS AT (800)473-2783.

ATTENTION PROVIDERS

THE OFFICE OF MANAGEMENT AND BUDGET (OMB), THE NATIONAL UNIFORM CLAIM COMMITTEE (NUCC) AND THE NATIONAL UNIFORM BILLING COMMITTEE (NUBC) HAVE GIVEN WITH STAMP OF APPROVAL TO THE NEW 1500 HEALTH INSURANCE CLAIM FORM (VERSION 08/05) AND THE NEW UB-04 CLAIM FORM. THE LOGISTICS FOR DISTRIBUTION AND TRANSITION TO THESE REVISED FORMS, INCLUDING EFFECTIVE DATES FOR USE BY PROVIDERS AND ACCEPTANCE BY PAYERS, IS UNDER REVIEW BY THE COMMITTEES. IT IS VERY IMPORTANT THAT YOU DO NOT BEGIN USING THESE NEW FORMS FOR LA MEDICAID BILLING UNTIL YOU ARE INFORMED OF THE EFFECTIVE DATE OF THE TRANSITION FOR LA MEDICAID CLAIMS PROCESSING. YOU WILL BE KEPT INFORMED OF ALL NECESSARY INFORMATION FOR IMPLEMENTING THESE FORMS FOR LA MEDICAID BILLING THROUGH RA MESSAGES, NEWSLETTER ARTICLES, AND PROVIDER NOTICES POSTED ON OUR WEBSITE, WWW.LAMEDICAID.COM <HTTP://WWW. LAMEDICAID.COM/>. PLEASE WATCH THESE INFORMATION AVENUES FOR THE MOST UP-TO-DATE INFORMATION FOR BILLING LA MEDICAID. 

ATTENTION PHYSICIAN, HOSPITAL, RHC/FQHC/IHS PROVIDERS
NEW TAKE CHARGE FAMILY PLANNING WAIVER PROGRAM 

DHH WILL IMPLEMENT A SECTION 1115 DEMONSTRATION WAIVER TO PROVIDE FAMILY
PLANNING SERVICES ONLY FOR WOMEN BETWEEN THE AGES OF 19-44 WHO DO NOT 
MEET MEDICAID CERTIFICATION CRITERIA BUT WHO HAVE INCOME UP TO 200% OF 
THE FEDERAL POVERTY LEVEL. THIS WAIVER PROGRAM, NAMED "TAKE CHARGE", 
HAS A SPECIFIED, LIMITED BENEFIT PACKAGE. SERVICES WILL INCLUDE YEARLY PHYSICAL EXAMS AND CERTAIN LABORATORY TESTS, CONTRACEPTIVE COUNSELING, MEDICATIONS, SUPPLIES, AND MEDICAL PROCEDURES. SERVICES MAY BE PROVIDED BY AN ENROLLED MEDICAID PROVIDER(S) WHOSE SCOPE OF PRACTICE PERMITS THE DELIVERY OF THE SERVICES COVERED BY THIS WAIVER PROGRAM. MORE SPECIFIC INFORMATION ABOUT THE TAKE CHARGE FAMILY PLANNING WAIVER WILL BE AVAILABLE IN A DETAILED PROVIDER NOTICE AT THE FOLLOWING LINKS:

HTTP://WWW.LAMEDICAID.COM/PROVWEB1/NEWINFORMATION/NEWINFORMATIONINDEX.HTM

HTTP://WWW.LAMEDICAID.COM/PROVWEB1/BILLING_INFORMATION/MEDICAID_BILLING_INDEX.HTM

THE IMPLEMENTATION DATE OF THE TAKE CHARGE FAMILY PLANNING WAIVER PROGRAM IS OCTOBER 2, 2006.