RA Messages for June 8, 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 FUL changes are
posted on www.lamedicaid. com
PHARMACISTS AND PHYSICIANS
Effective June 17, 2009, edits
will be placed on Suboxone and Subutex prescriptions. The physician must FAX a
copy of his/her current Controlled Substance Registration Certificate indicating
the XDEA number and updated Provider Enrollment information to 1-225-216-6392.
Prescriptions require a diagnosis code of opioid dependence. Maximum daily dose
of Suboxone is 24mg and Subutex is 16mg/day. Only original prescriptions will be
reimbursed. Concurrent prescriptions of other opioid analgesics and/or
benzodiazepines from other prescribers will deny.
The Drug File used in claims
processing is being phased to First Data Bank's Standard Format. The first phase
of conversion will take place on Sunday, June 14. With this conversion, there
are a few drugs which will have billing unit type changes. These drugs include
Sumatriptan Succinate and Lucentis. Please visit www.lamedicaid.com or contact
the POS Help Desk for specific billing unit type changes.
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
PATHOLOGY SERVICES PROVIDERS
Louisiana Medicaid was made aware of system issues with the processing
of claims for CPT codes 88187 (Flow cytometry, interpretation; 2 to 8
markers), 88188 (Flow cytometry, ...9 to 15 markers), and 88189 (Flow
cytometry, ...16 or more markers). Changes have been made to allow
these claims to properly process. Claims that improperly denied for
these services have been identified and recycled. The recycled claims
are scheduled to appear on the R/A of June 8, 2009, and include
dates of service beginning with January 1, 2005. No action is required
PROVIDERS: CLAIMS WITH
PLACE OF SERVICE 15 (MOBILE UNIT) OR 20 (URGENT CARE FACILITY)
submitted with Place of Service 15 or 20 with Dates of Service on or
after 9/1/2007 that were erroneously denied for Error 084 (Invalid Place
of Treatment) are being systematically recycled for correct processing.
These claims should appear on the RA of June 8, 2009. No action is
required by providers.