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 PHARMACISTS

THE DEPT. OF HEALTH AND HOSPITALS, BUREAU OF HEALTH SERVICES FINANCING IS REPEALING THE FEB. 20, 2006 RULE THAT CHANGED THE REIMBURSEMENT RATE FOR ANTIHEMOPHELIA DRUGS, TO AWP-30%. THE REIMBURSEMENT METHODOLOGY PRIOR TO THIS FEB. 20, 2006 RULE WILL NOW APPLY TO ALL PHARMACY PROVIDERS. DHH WILL RECYCLE CLAIMS FOR ANTIHEMOPHELIA DRUGS FOR ALL PHARMACY PROVIDERS EXCEPT 340B PHARMACY PROVIDERS. THEREFORE, PHARMACY PROVIDERS THAT ARE NOT 340 B PROVIDERS DO NOT HAVE TO RE-SUBMIT THESE CLAIMS FOR PROCESSING. HOWEVER, 340-B PROVIDERS MUST RE-SUBMIT THESE CLAIMS FOR ACTUAL ACQUISITION COST + $8.10. THE LA. MEDICAID PHARMACY BENEFITS MANAGEMENT PROVIDER MANUAL WILL BE UPDATED TO REFLECT THIS CHANGE. 

ATTENTION UCC PROVIDERS:

BEGINNING AUGUST 1, 2006 YOU CAN START SUBMITTING ADJUSTMENTS, VOIDS AND RESUBMITS OF DENIED CLAIMS. YOU WILL HAVE UNTIL SEPTEMBER 15, 2006 AT MIDNIGHT TO COMPLETE THE ABOVE REFERENCED TRANSACTIONS. THESE MAY BE SUBMITTED USING THE UCC WEB APPLICATION ONLY. NO PAYMENTS WILL BE MADE AFTER SEPTEMBER 30, 2006. REFERENCE THE UCC WEB USER GUIDE FOR INSTRUCTIONS AT 
<HTTP://WWW.LAMEDICAID.COM/PROVWEB1/HURRICANERELIEFPOOLPLAN.HTM>

ATTENTION SUPPORT COORDINATION SERVICE PROVIDERS

EFFECTIVE 8-1-2006, ALL SUPPORT COORDINATION SERVICE PROVIDERS WILL HAVE ACCESS TO THE LOUISIANA MEDICAID PRIOR AUTHORIZATION REQUEST FOR CASE MANAGERS' SYSTEM. THE PURPOSE OF THE PA REQUEST FOR CASE MANAGERS' SYSTEM IS TO PROVIDE SUPPORT COORDINATION SERVICE PROVIDERS THE CAPABILITY TO VIEW PRIOR AUTHORIZATION REQUESTS FOR RECIPIENTS LINKED TO THEIR AGENCIES THAT ARE SUBMITTED VIA THE ELECTRONIC PRIOR AUTHORIZATION (E-PA) SYSTEM BY THE SERVICING PROVIDER. ACCESS INSTRUCTIONS ARE LOCATED ON THE LAMEDICAID WEBSITE: HTTP://WWW.LAMEDICAID.COM. 

ADDITIONAL COMMUNITYCARE EXEMPTIONS

AS PREVIOUSLY STATED IN THE MAY/JUNE 2006 LOUISIANA MEDICAID PROVIDER UPDATE, IN ACCORDANCE WITH CMS STATE PLAN REQUIREMENTS, EFFECTIVE 9-1-06 THE FOLLOWING GROUPS OF MEDICAID RECIPIENTS ARE NOW EXEMPT FROM MANDATORY PARTICIPATION IN THE COMMUNITYCARE PROGRAM: SSI RECIPIENTS UNDER THE AGE OF 19, NEW OPPORTUNITIES WAIVER (NOW) RECIPIENTS UNDER THE AGE OF 19, CHILDREN'S CHOICE WAIVER RECIPIENTS UNDER THE AGE OF 19, COMMUNITY SUPPORT WAIVER RECIPIENTS UNDER THE AGE OF 19. PCPS SHOULD BE ADVISED THAT THEY MAY SEE A DECREASE IN THE NUMBER OF COMMUNITYCARE ENROLLEES LINKED TO THEIR PRACTICE AS A RESULT OF THESE NEW EXEMPTIONS. 

USE OF UNLISTED CPT CODES FOR GASTRIC BYPASS SURGERY

EFFECTIVE IMMEDIATELY, PROVIDERS SHOULD USE THE APPROPRIATE CPT CODE WHEN SUBMITTING PRIOR AUTHORIZATION REQUESTS AND CLAIMS FOR GASTRIC BYPASS SURGERY. SUBMISSIONS USING AN "UNLISTED' PROCEDURE CODE WHEN THERE IS A VALID CPT CODE FOR THE PROCEDURE WILL BE DENIED. 

STERILIZATION CONSENT FORMS

PROVIDERS MAY CONTINUE TO USE THE STERILIZATION CONSENT FORM AVAILABLE FROM THE OFFICE OF POPULATION AFFAIRS (OPA) AND THEIR WEBSITE AFTER THE DATE LISTED ON THE CURRENT FORM. OPA IS HAVING AN UPDATED CONSENT FORM PRINTED THAT SHOULD BE AVAILABLE BY THE END OF THE YEAR. PROVIDERS ARE STRONGLY ENCOURAGED TO USE THE MOST UP TO DATE FORM AVAILABLE. THE OPA WEBSITE IS: HTTP://OPA.OSOPHS.DHHS.GOV/PUBS/PUBLICATIONS.HTML . 

ATTENTION PHYSICIANS - VAGUS NERVE STIMULATORS

AS A RESULT OF THE 2006 LOUISIANA HOUSE CONCURRENT RESOLUTION NO. 1, PROCEDURE FILE CHANGES HAVE BEEN MADE TO ALLOW THE IMPLANTATION OF A VAGUS NERVE STIMULATOR (VNS) TO BE "PERFORMED BY A SURGEON WHO HAS BEEN PROPERLY TRAINED AND IS FAMILIAR WITH THE CAROTID SHEATH." ADDITIONALLY, THE PROGRAMMING OF THE VNS MAY BE "PERFORMED BY THE SURGEON WHO PERFORMED THE IMPLANT PROCEDURE OR BY A LICENSED NEUROLOGIST OR PSYCHIATRIST." LOUISIANA MEDICAID HAS MADE NO CHANGES IN COVERED DIAGNOSES OR OTHER RELATED CRITERIA. 

ATTENTION PROFESSIONAL SERVICES PROVIDERS

A SYSTEM PROCESSING ERROR HAS CREATED DUPLICATE MEDICARE PART B CROSSOVER CLAIM PAYMENTS. THESE DUPLICATE CLAIMS WILL BE VOIDED AND THE RECOUPMENT ACTIONS REFLECTED IN REMITTANCES BEGINNING IN THE NEXT TWO WEEKS. PROVIDERS NEED NOT TAKE ANY ACTIONS TO CORRECT THESE PAYMENTS. 

ATTENTION OPTOMETRISTS

CERTAIN PAYABLE CODES FOR OPTOMETRISTS INAPPROPRIATELY DENIED ON MEDICAID REMITTANCES DATED 8/29/06 AND 9/05/06. THESE DENIED CLAIMS WILL BE REPROCESSED AND PAYMENT SHOULD APPEAR ON YOUR REMITTANCE DATED 9/12/06. WE REGRET ANY INCONVENIENCE THIS ERROR MAY HAVE CAUSED.