RA Messages for May 11, 2009
PHARMACY PROVIDERS, PLEASE
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.
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
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.
PROVIDERS: CHANGES IN TRANSMITTING COMMUNITYCARE PCP
REFERRAL AUTHORIZATION NUMBERS FOR EDI CLAIMS
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.
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.
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.