RA Messages for May 11, 2009


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

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

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


For Medicaid pharmacy services effective May 1, 2009, the Department of Health and Hospitals, Bureau of Health Services Financing will establish a five-prescription limit per recipient per calendar month. Please refer to www.lamedicaid.com for detailed information.


Effective with date of processing June 1, 2009, service providers will be required to transmit the PCP's 10-digit NPI as the CommunityCARE Referral Authorization Number on EDI claims transactions. A detailed provider notice, containing important information for both PCPs and servicing providers that must have a referral, is posted on the homepage of the LA Medicaid website, www.lamedicaid.com. Please visit the website to obtain this needed information in order to make all necessary changes and be prepared for this transition to avoid unnecessary claim denials.


Updates to the Pharmacy Benefits Management Services Manual are now available on the Louisiana Medicaid website at www.lamedicaid.com. Pharmacy providers should refer to the manual for a complete description of Medicaid pharmacy program policy.


Effective March 30, 2009, HMS assumed the responsibility of updating the TPL Resource Files for recipients with private insurance and Medicare Advantage Plans. Prior to this transition to HMS, providers were given the option to either submit the form via fax or to continue to mail the form with the affected claims to the TPL Unit. Effective immediately: (1) All TPL update requests for private insurance and Medicare Advantage Plans must be submitted to HMS. The HMS update form must be FAXED to HMS at 1-877-204-1325. (2) All TPL update requests for traditional Medicare should continue to be FAXED to the DHH TPL Unit at 225-342-1376. In each instance, an EOB or carrier letter supporting the requested update should be included when/if available. Providers should discontinue submitting claims with the TPL Information Update form. Any claims submitted with these requests will not be processed; they will be considered documentation only. Processing of your requests should only take one week. Providers should hold any and all claims until the recipient file is updated, then submit the claims through normal processing channels. Providers should check this information through the recipient eligibility options, e-MEVS, MEVS, or REVS, to ensure that the update has occurred. The TPL update forms are located on the homepage of the LA Medicaid website, www.lamedicaid.com, under the link, "TPL Information." Questions concerning HMS updates (private insurance and Medicare Advantage Plans) should be addressed to HMS at 1-877-204-1324. Questions concerning DHH updates (traditional Medicare) should be addressed to the DHH TPL Unit at 225-342-8662.