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 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. 

IMPORTANT NOTICE TO ALL ORDERING AND RENDERING PROVIDERS OF
HIGH-TECH RADIOLOGY SERVICES
RADIOLOGY UTILIZATION MANAGEMENT (RUM)

Louisiana Medicaid has identified an issue related to the reimbursement of claims for Radiologic services, whereby claims were paid without an approved Prior Authorization on file. We have identified and corrected the logic that allowed these claims to pay and have identified those claims paid in error. These are claims that were paid against a valid Prior Authorization, but the specific line for the procedure code was either denied or withdrawn, but the claim still paid. The claims that were paid in error will be voided on the 07/05/11 RA. If you have any billing or policy questions, please contact Provider Relations at (800) 473-2783 or (225) 924-5040.

ATTENTION ALL PROVIDERS

For the month of July 2011, the check writes will be scheduled for Wednesday July 6th, July 13th, July 20th and July 27th. Direct deposit funds will be available on the Thursdays following the check write date. Please notify all of your billing personnel as well as business associates handling billing and/or remittance posting on your behalf. Long Term Supplemental Billing is scheduled for July 20th and July 27th. This change does not impact the regular EDI cut off dates and times, except for LTC supplemental billings.

EFFECTIVE DATE FOR THE COMMUNITY CHOICES WAIVER

Implementation of the new Community Choices Waiver that will replace the current Elderly and Disabled Adult (EDA) Waiver will be October 1, 2011.

ATTENTION ADULT DAY CARE PROVIDERS 

Due to a claims processing problem, some Adult Day Care provider claims were improperly denied in the check write of July 06, 2011. The current payment dated July 14, 2011 includes a recycle of these denied claims. ADHC providers have until July 19th to submit all claims with June dates of service as well as other claims not previously submitted in order to assure processing on July 27, 2011.