RA Messages for January 12, 2009


If you are unsure about the coverage of a drug product, please contact the PBM help desk at 1-800-648-0790.  

Detailed FUL changes are posted on www.lamedicaid.com.


page 49 IBUPROFEN TABLETS,     600mg     $0.41700, eff 01/12/09
page 72 NYSTATIN/TRIAM. CR,    15mg       $0.28533, eff 05/01/04
page 72 NYSTATIN/TRIAM. CR,    30mg       $0.09750, eff 01/22/02
page 72 NYSTATIN/TRIAM. CR,    60mg       $0.18816, eff 05/01/04
page 72 NYSTATIN CR, 15mg,        30mg       $0.09900, eff 01/12/09

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


Louisiana Medicaid is in the process of completing the programming for the 2009 HCPCS updates. This includes both new and deleted codes for 2009. Every attempt is being made to have the new codes/updates on file by mid January 2009. Please note that all appropriate editing and coverage determinations for the new codes may not be final at that time and adjustments to claims processed may be necessary. Providers should monitor future RA messages.


The Louisiana Legislature has funded additional New Opportunity Waiver slots through the NOW Trust Fund. Most New Opportunity Waiver slots filled on or after November 3, 2008 are part of the NOW Trust Fund. A system for processing claims for recipients of this group is currently in development. Claims for any Medicaid services provided for NOW Trust Fund recipients of waiver slots will not be accepted until after January 1, 2009. At that time, all claims for these recipients will be held as "pending" with a tentative payment begin date of February 1, 2009. However, providers will be notified as soon as programming is completed, and payment of the pending claims will move forward for final processing at that time.


Effective for dates of service on and after December 24, 2008, changes will be imposed for the EPSDT Dental Program including increased reimbursement for certain procedures, revised policy regarding root canals, and coverage of five additional procedures. Implementation of these changes may be delayed if required programming changes are not complete; however, if this occurs, Medicaid will recycle affected claims. Complete details will be placed on the www.lamedicaid.com website under the "New Medicaid Information," "Billing Information," and "Fee Schedule" links. If you have questions, you may contact the LSU Dental Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free).


As a result of the bypass for specific errors relating to Hurricane Gustav, we have identified that some Inpatient, Outpatient, Physician, and Home Health claims were paid erroneously. The majority of these claims paid at zero. We have identified the claims impacted and they are being voided on this week's Remittance Advice (1/13/09). These voided claims will need to be reviewed for potential errors and resubmitted with the correct information so that they can be processed. If you have questions concerning this process, please contact Provider Relations at (800) 473-2783 or (225) 924-5040.