RA Messages for September 25, 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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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 POLICY INFORMATION INCLUDING RECENTLY RELEASED FREQUENTLY ASKED QUESTIONS REGARDING TAMPER-RESISTANT PRESCRIPTION PADS.

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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.

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ATTENTION DENTAL PROVIDERS - NOTIFICATION

ADDRESS & TELEPHONE NUMBER CHANGE FOR THE LSU DENTAL MEDICAID UNIT EFFECTIVE IMMEDIATELY, DENTAL PROVIDERS MUST BEGIN USING THE FOLLOWING NEW ADDRESS WHEN SUBMITTING DENTAL PRIOR AUTHORIZATION REQUESTS OR OTHER DENTAL-RELATED CORRESPONDENCE TO THE LSU DENTAL MEDICAID UNIT: LSU DENTAL MEDICAID UNIT, P.O. BOX 19085, NEW ORLEANS, LA 70179-9085. THE NEW TELEPHONE NUMBERS FOR THE LSU DENTAL MEDICAID UNIT ARE AS FOLLOWS: 504-941-8206 OR 1-866-263-6534 (TOLL-FREE).

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ATTENTION PROVIDERS AND ENTITIES

THE DEFICIT REDUCTION ACT OF 2005, SECTION 6032 IMPLEMENTATION. AS A CONDITION OF PAYMENT FOR GOODS, SERVICES AND SUPPLIES PROVIDED TO RECIPIENTS OF THE MEDICAID PROGRAM, PROVIDERS AND ENTITIES MUST COMPLY WITH THE FALSE CLAIMS ACT EMPLOYEE TRAINING AND POLICY REQUIREMENTS IN 1902(A)(68) OF THE SOCIAL SECURITY ACT, SET FORTH IN THAT SUBSECTION AND AS THE SECRETARY OF US DEPARTMENT OF HEALTH AND HUMAN SERVICES MAY SPECIFY. AS AN ENROLLED PROVIDER/ENTITY, IT IS YOUR OBLIGATION TO INFORM ALL OF YOUR EMPLOYEES AND AFFILIATES OF THE PROVISIONS OF THE FEDERAL FALSE CLAIMS ACT, AND ANY LOUISIANA LAWS AND/OR RULES PERTAINING TO CIVIL OR CRIMINAL PENALTIES FOR FALSE CLAIMS AND STATEMENTS, AND WHISTLEBLOWER PROTECTIONS UNDER SUCH LAWS AND/OR RULES. WHEN MONITORED OR AUDITED, YOU WILL BE REQUIRED TO SHOW EVIDENCE OF COMPLIANCE WITH THIS REQUIREMENT. THIS PROVISION REQUIRES ANY ENTITY THAT RECEIVES ANNUAL MEDICAID PAYMENTS UNDER THE STATE PLAN OF AT LEAST $5 MILLION TO PROVIDE FEDERAL FALSE CLAIMS ACT EDUCATION TO THEIR EMPLOYEES.

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ATTENTION HOSPICE PROVIDERS - MSA CODE ASSIGNMENT

EFFECTIVE WITH DATES OF SERVICE 10/1/07, THE MSA CODES CURRENTLY USED FOR BILLING HOSPICE SERVICES IN THE FOLLOWING PARISHES HAVE BEEN CHANGED TO:

CAMERON-3960         GRANT-0220                      DESOTO-7680             E. FELICIANA-0760

IBERVILLE-0760          POINTE COUPEE-0760     ST.HELENA-0760       UNION-5200

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COMMUNITYCARE NOTICE TO ALL MEDICAID PROVIDERS

DUE TO THE EFFECTS OF HURRICANES KATRINA AND RITA, DHH SUSPENDED MANDATORY COMMUNITYCARE LINKAGES IN SOME OF THE MOST HEAVILY AFFECTED AREAS. EFFECTIVE 10/1/07, DHH WILL RESUME MANDATORY LINKAGES IN ORLEANS (36) AND CAMERON (12) PARISHES. COMMUNITYCARE PCPS IN THESE PARISHES SHOULD NOTICE AN INCREASE IN THE NUMBER OF COMMUNITYCARE LINKAGES ON THEIR CP-0-92 REPORT BEGINNING 10/07. ALL PROVIDERS SHOULD BE AWARE THAT MEDICAID PATIENTS WHOM THEY HAVE BEEN TREATING MAY BECOME LINKED TO A COMMUNITYCARE PCP EFFECTIVE 10/1/07. IN ORDER TO BE REIMBURSED BY MEDICAID, PROVIDERS WHO ARE NOT THE PCP OF RECORD MUST HAVE A REFERRAL/ AUTHORIZATION FROM THE APPROPRIATE PCP (AS REFLECTED ON THE MEDICAID ELIGIBILITY VERIFICATION SYSTEM) PRIOR TO PROVIDING SERVICES. IT IS THE MEDICAID PROVIDER'S RESPONSIBILITY TO VERIFY RECIPIENT ELIGIBILITY/COMMUNITYCARE.