RA Messages for May 19, 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


Please note that the only codes payable in combination with HR490 (outpatient ambulatory surgery) for TAKE CHARGE recipients are 58301, 58600, 58615, 58670, and 58671. Any HCPS other than these will deny when billed in combination with HR 490.


Updates have been made to the procedure file related to CPT codes 83913 (Molecular Diagnostics...) and 86357 (Natural Killer Cells...). A recycle of affected claims is complete and providers should see the recycled claims on the RA of May 12, 2009. No action is required by providers.

To maintain compliance with CMS guidelines in not exceeding the Medicare reimbursement rate for clinical laboratory procedures, Louisiana Medicaid's reimbursement for CPT codes 80047 (Basic Metabolic Panel...) and 82962 (Glucose, blood...) was updated effective with date of service January 1, 2009. Claims paid at the previous rate were systematically adjusted and those adjustments should appear on the RA of May 12, 2009. No action is required by providers.


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.