RA Messages for June 16, 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
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
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.
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.
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.
SUPPORTS WAIVER AND ELDERLY
AND DISABLED (EDA) MEDICAID PROVIDERS
a budget deficit, rate reductions were implemented for certain services
in the Medicaid Program. Unfortunately, some support coordination
procedure codes were inadvertently included in those reductions, causing
some claims to be paid at an incorrect lower rate. File updates have
been completed and claims are recycled on the RA of 6/16/09. These
recycled claims are identified with EOB code 570.
UPDATE: 'PROFESSIONAL SERVICES, LAB, X-RAY, AND ASC'
Medicaid has begun an update to the procedure file beginning with select
CPT codes from the 'Urinary System,' 'Male Genital System,' 'Female
Genital System,' and 'Cytopathology' sections of the CPT manual. The
updates affected age, sex, and global surgery period indicators.
Revisions of this nature should not adversely impact correctly submitted
claims by providers. We anticipate that these updates will be reflected
on the published fee schedule beginning July 2009.
Reimbursement and program changes are implemented in the Extended Dental
Services for Pregnant Women's dental program, as well as the addition of
a new dental procedure code to the EPSDT dental program. Complete
details can be located on the www.lamedicaid.com website under the
'Billing Information' and 'Fee Schedule' links. Contact the LSU Dental
Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free) with any
INFORMATION RELATED TO PROVIDING SERVICES TO TAKE CHARGE
ATTENTION ALL PROVIDERS
receiving many, many calls from recipients enrolled in the TAKE CHARGE
Family Planning Waiver Program regarding bills they have received on
denied services. Many of the denials are because a provider used an
incorrect (non-covered) procedure/diagnosis code on the claim. Other
denials are because providers did not check eligibility to determine
that the recipient has limited coverage through TAKE CHARGE, and/or
medical charts are not flagged to indicate that the patient is a TAKE
CHARGE recipient. This recipient population has limited coverage and
providers can refer to the LA Medicaid website at
www.lamedicaid.com to verify
covered services with their respective billable codes.