RA Messages for September 6, 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
PLEASE MAKE THE FOLLOWING CHANGES TO THE APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 00043 |
NOVARTIS
CONSUMER HEALTH INC |
|
10/01/05 |
| 10135 |
MARLEX
PHARMACEUTICALS INC |
|
10/01/05 |
| 10144 |
ACCORDA
THERAPEUTICS, INC |
10/01/05 |
|
| 10631 |
RANBAXY
LABORATORIES INC |
10/01/05 |
|
| 10922 |
INTENDIS
INC |
10/01/05 |
|
| 12948 |
NITROMED
INC |
10/01/05 |
|
| 13107 |
AUROBINDO
PHARMA USA, INC |
07/01/05 |
|
| 13279 |
ALLAN
PHARMACEUTICAL LLC |
10/01/05 |
|
| 13533 |
TALECRIS
BIOTHERAPEUTICS INC |
10/01/05 |
|
| 13913 |
DEPOMED
INC |
10/01/05 |
|
| 58552 |
GIL
PHARMACEUTICAL CORP |
|
10/01/05 |
| 53265 |
ABLE
LABORATORIES, INC |
|
07/01/05 |
| 59291 |
IYATA
PHARMACEUTICALS INC |
|
10/01/05 |
| 59441 |
SHIRE
US INC |
|
10/01/05 |
| 65430 |
DEX
GEN PHARMACEUTICAL INC |
|
07/01/05 |
| 65939 |
LIFECYCLE
VENTURES INC |
|
10/01/05 |
| 66780 |
AMYLIN
PHARMACEUTICALS, INC |
10/01/05 |
|
| 68158 |
PRAECIS
PHARMACEUTICALS INC |
|
10/01/05 |
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.
*********URGENT***********URGENT**********URGENT**********URGENT********
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.
*********URGENT***********URGENT**********URGENT**********URGENT********
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.