RA Messages for January 15, 2008


PHARMACY PROVIDERS, PLEASE NOTE!!!


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 A:
DRUG                                                             DOSAGE         STRGTH             MAC                 EFF
ANTHRALIN                                             CREAM(GM)             1%         OFF MAC             01/04/08
ERGOLOID MESYLATES                             TABLET               1MG        OFF MAC             01/04/08
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. PARTI-
CIPATION MAY BE VERIFIED IN APPENDIX C, AVAILABLE AT WWW.LAMEDICAID.COM
 


URGENT: Attention Providers AND BILLING VENDORS

 
THE FEDERAL STATUTE REQUIRING THE USE OF THE NATIONAL DRUG CODE (NDC) ON CLAIMS FOR PHYSICIAN ADMINISTERED DRUGS EFFECTIVE JANUARY 2008 WILL BE IMPLEMENTED IN THE MEDICAID CLAIMS PROCESSING SYSTEM AND WILL RESULT IN DENIAL OF NON-COMPLIANT CLAIMS IN THE NEAR FUTURE. THE NDC NUMBER AND THE HCPCS CODE FOR DRUG PRODUCTS WILL BE REQUIRED ON THE 837P, THE CMS-1500,THE 837I, AND THE UB04 CLAIM FORMS FOR REIMBURSABLE MEDICATIONS. THE EFFECTIVE DATE OF THE NDC REQUIREMENT ON SYSTEM EDITS HAS NOT YET BEEN DETERMINED. PROVIDERS AND BILLING VENDORS ARE REQUESTED TO IMMEDIATELY BEGIN UPDATING THEIR BILLING SYSTEMS, COMPLETE THE NECESSARY CHANGES TO INFORMATION SYSTEMS, AND UPDATE INTERNAL POLICIES AND PROCEDURES TO ENSURE THAT THESE REQUIREMENTS ARE MET. BILLING INSTRUCTIONS CAN BE FOUND IN THE 2007 TRAINING MANUALS FOR PROFESSIONAL SERVICES, KIDMED, AND RHC/FQHC
SERVICES IN THE SECTION OF INFORMATION PERTAINING TO THE CMS-1500 FORM.

BILLING INSTRUCTIONS FOR THE UB04 AND 837I WILL BE FORTHCOMING. PROVIDERS WILL BE GIVEN SUFFICIENT TIME TO MAKE THE NECESSARY CHANGES TO THEIR BILLING SYSTEM PRIOR TO IMPLEMENTATION.

PROVIDERS AND BILLING VENDORS MUST MONITOR THE LOUISIANA MEDICAID WEBSITE AT WWW.LAMEDICAID.COM AND REMITTANCE ADVICE MESSAGES FOR IMPORTANT INFORMATION REGARDING THE DATE OF IMPLEMENTATION AND FURTHER INSTRUCTIONS.