LOCK-IN PROGRAM

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The Bureau of Health Services Financing (BHSF) has developed a program to educate recipients who may be unintentionally misusing program benefits and to ensure that program funds are used to provide optimum health services for recipients.  Recipients who misuse pharmacy and physician benefits may be restricted to the use of one pharmacy and/or one physician.

A Lock-In recipient is asked to choose one physician provider and one pharmacy provider to be the Lock-In providers.  Under most circumstances, recipients with providers listed under the Lock-In segment of REVS or MEVS are restricted to receiving physician and pharmacy services from these providers.  If a patient chooses to change his Lock-In provider or add a specialist, they must go to the local parish office.  If a provider chooses to no longer be a recipient’s Lock-In provider, he should contact the Lock-In Unit at (225) 216- 6245 or 
fax (225)216-6334.

Providers not named on the Lock-In segment accessed through MEVS or REVS can provide services; however, no payment will be made to these providers.  The BHSF recognizes that there will be unusual circumstances when it is necessary for a pharmacy or physician provider to grant services for a Lock-In recipient when the provider is not named on REVS or MEVS.  Payment will be made to any physician or pharmacist enrolled in Louisiana Medicaid who grants services to a Lock-In recipient in emergency situations or when life-sustaining medicines are required.  If a physician who is not named on the recipient's Lock-In segment renders an emergency service to the recipient, the provider should submit a claim to Unisys and write "Emergency" in the diagnosis section of the claim form.  The physician should also write "Emergency" on any prescription resulting from such an emergency.

There may be circumstances under which it is necessary for a Lock-In physician to refer the Lock-In recipient for consultation on a one-time basis.  The consulting physician may be reimbursed for the consultation if that consulting physician enters the name and provider number of the referring Lock-In physician in the Referring Physician block on the claim.  If the consulting physician subsequently becomes the treating physician, that physician should remind the recipient to report this information to the BHSF local parish office, because reimbursement cannot be made for continued services until the provider's name and number are entered on the recipient's Lock-In segment.

Pharmacists other than those named in the recipient's Lock-In segment may fill prescriptions for life-sustaining medication or upon receiving a prescription containing the term "Emergency" R_x.  They should certify that the prescription is an emergency on their hardcopy claim forms and then forward to:

Unisys Provider Relations Correspondence Unit
ATTN:  Lisa Patterson
P.O. Box 91024
Baton Rouge, LA  70802

The Lock-In system affects the recipients only in the areas of physician and pharmacy services.  Providers other than physicians or pharmacists may provide the services, which they normally do for any eligible recipient.