RA Messages for May 27, 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 B:
NDC                                     TRADENAME                                                                                                         DOSAGE
53746-0141-01                 ISOMETH-D-CHLORALPHENAZ-APAP                                                                 CAPSULE
53746-0141-02                 ISOMETH-D-CHLORALPHENAZ-APAP                                                                 CAPSULE
53746-0141-05                 ISOMETH-D-CHLORALPHENAZ-APAP                                                                 CAPSULE
53746-0141-50                 ISOMETH-D-CHLORALPHENAZ-APAP                                                                 CAPSULE
60258-0840-25                 AMINOBENZOATE POTASSIUM                                                                            CAPSULE
64125-0132-01                 CLIDINIUM-CHLORDIAZEOOXIDE                                                                        CAPSULE
64125-0132-10                 CLIDINIUM-CHLORDIAZEOOXIDE                                                                        CAPSULE
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
 


ATTENTION PROVIDERS: EFFECTIVE WITH PROCESSING DATE MAY 23, 2008

(RA DATE 5/27/08) FOR DATES OF SERVICE MARCH 1, 2008 AND AFTER, OUT PATIENT HOSPITAL CLAIMS AND LICENSED HEMODIALYSIS CENTER CLAIMS ARE REQUIRED TO SUBMIT NDC INFORMATION AND THE CORRESPONDING HCPCS CODE FOR PHYSICIAN-ADMINISTERED DRUGS ON THE 837I (INSTITUTIONAL TRANSACTION) AND THE UB-04 CLAIM FORM. UPDATED BILLING INSTRUCTIONS FOR THE UB-04 FORM ARE NOW LOCATED ON THE LA MEDICAID WEBSITE UNDER BILLING INFORMATION AND NEW MEDICAID INFORMATION LINKS. UPDATED BILLING INSTRUCTIONS FOR LICENSED HEMODIALYSIS CENTERS ARE FORTHCOMING. PLEASE MONITOR RA MESSAGES AND THE WEBSITE TO LEARN WHEN THESE INSTRUCTIONS BECOME AVAILABLE. THE REVISED EDI COMPANION GUIDE FOR THE 837I IS AVAILABLE ONLINE. THE NDC INFORMATION MUST BE ENTERED ON THE CLAIM SUBMISSION EXACTLY AS INDICATED IN THE BILLING INSTRUCTIONS TO PREVENT FUTURE CLAIM DENIALS. EFFECTIVE WITH DATE OF PROCESSING JULY 1, 2008, CLAIMS THAT DO NOT CONTAIN THE REQUIRED, ACCURATE NDC INFORMATION SUBMITTED WILL DENY.


ATTENTION PROFESSIONAL SERVICES PROVIDERS

 PRENATAL VISITS: 2007 REIMBURSEMENT CHANGES AND ADJUSTMENTS
ALERT: CHANGE FROM PRIOR MESSAGE

THE RA MESSAGE THAT RAN ON 5-6-08 AND 5-13-08 INDICATED THAT THE PRENATAL SERVICES (VISITS MODIFIED WITH TH)IMPACTED BY THE RATE CHANGE EFFECTIVE WITH DATES OF SERVICE ON OR AFTER 10-15-07 WERE BEING SYSTEMATICALLY ADJUSTED WITH A RECYCLE TO APPEAR ON THE RA OF 5-13-08. HOWEVER, ALL OF THE CLAIMS IN THE ADJUSTMENT INADVERTENTLY DENIED FOR ERROR 799- NO HISTORY RECORD ON FILE FOR THIS ADJUSTMENT. FOR THIS REASON, THE
ADJUSTMENT OF THESE CLAIMS WILL NOW APPEAR ON THE RA OF 5-20-08. NO ACTION IS REQUIRED BY PROVIDERS. WE REGRET ANY INCONVENIENCE THIS MAY HAVE CAUSED. AS PART OF THE REIMBURSEMENT CHANGES FUNDED IN THE 2007 LEGISLATIVE SESSION AND APPROVED BY CMS, EFFECTIVE WITH DATES OF SERVICE ON OR AFTER 10-15-07, THE SAME METHODOLOGY USED IN RATE CHANGES FOR THE OTHER SELECTED PHYSICIAN SERVICES HAS BEEN APPLIED TO PRENATAL OFFICE VISITS (VISITS MODIFIED WITH TH). SEE THE RA MESSAGE OF 3-18-08 FOR DETAILS OF THE METHODOLOGY USED. THE PROFESSIONAL SERVICES FEE SCHEDULE THAT INCLUDES THESE SERVICES CAN BE FOUND ON WWW.LAMEDICAID.COM.


ATTENTION HEMODIALYSIS AND HOSPITAL PROVIDERS

UPDATED UB-04 BILLING INSTRUCTIONS, INCLUDING INFORMATION FOR BILLING REQUIRED NDC DATA FOR BOTH HEMODIALYSIS CENTERS AND HOSPITAL PROVIDERS, ARE NOW LOCATED ON THE LA MEDICAID WEB SITE TO ASSIST YOU IN SUBMITTING NDC/HCPCS CODE INFORMATION FOR PHYSICIAN-ADMINISTERED DRUGS ON THE 837I (INSTITUTIONAL TRANSACTION) AND THE UB-04 CLAIM FORM. THIS REQUIREMENT IS EFFECTIVE WITH PROCESSING DATE MAY 23, 2008 (RA DATE 5/27/08) FOR DATES OF SERVICE MARCH 1, 2008 AND AFTER FOR OUTPATIENT HOSPITAL CLAIMS AND LICENSED HEMODIALYSIS CENTER CLAIMS. THESE INSTRUCTIONS ARE LOCATED UNDER THE BILLING INFORMATION LINK AND THE NEW MEDICAID INFORMATION LINK. THE REVISED EDI COMPANION GUIDE FOR THE 837I IS AVAILABLE ON THE WEB SITE. THE NDC INFORMATION MUST BE ENTERED ON THE CLAIM SUBMISSION EXACTLY AS INDICATED IN THE BILLING INSTRUCTIONS TO PREVENT FUTURE CLAIM DENIALS. EFFECTIVE WITH DATE OF PROCESSING JULY 1, 2008, CLAIMS THAT DO NOT CONTAIN THE REQUIRED, ACCURATE NDC INFORMATION SUBMITTED WILL DENY.


ATTENTION ALL PROVIDERS THAT ARE REQUIRED TO ENTER NDC DATA ON CLAIM SUBMITTALS

A LINK CONTAINING SPECIFIC QUESTIONS AND ANSWERS RELATED TO THE ENTRY OF NDC DATA ON CLAIMS HAS BEEN ADDED TO THE LA MEDICAID WEB SITE. THIS Q&A MAY CLARIFY THE MORE SPECIFIC QUESTIONS CONCERNING ENTERING NDC DATA ON CLAIMS. THIS INFORMATION IS LOCATED ON THE HOME PAGE LINK, NDC INFORMATION ON CLAIMS SUBMISSIONS FOR PHYSICIAN-ADMINISTERED DRUGS.


ATTENTION HOSPITAL PROVIDERS

HCPC CODES REQUIRED FOR OUTPATIENT CLAIMS/OUTPATIENT HOSPITAL SERVICES FEE SCHEDULE - EFFECTIVE FOR DATES OF SERVICE ON OR AFTER JUNE 1, 2008, IN KEEPING WITH THE NATIONAL UNIFORM BILLING STANDARDS, HOSPITALS ARE REQUIRED TO REPORT THE CORRESPONDING HCPC CODE WITH REVENUE CODES FOR SERVICES AS REQUIRED BY NUBC. INDIVIDUAL CLAIM LINES THAT ARE BILLED WITHOUT THE REQUIRED HCPC CODE WILL DENY WITH ERROR CODE 513 "HCPC REQUIRED." THIS APPLIES TO BOTH ELECTRONIC AND HARD COPY CLAIMS. IN ADDITION, THE OUTPATIENT HOSPITAL SERVICES FEE SCHEDULE WILL BE POSTED ON THE LA MEDICAID WEB SITE BY JUNE 1, 2008. PAYMENT METHODOLOGY WILL NOT CHANGE.