RA Messages for July 15, 2008
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.
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
ATTENTION PHARMACY PROVIDERS
Please be advised that certain
pharmacy claims billed to Medicare part b which crossed over to Medicaid
and denied have been recycled for Medicaid payment. These claims were
billed with procedure codes recently updated by Medicare. The Medicaid
system has now been adjusted to accept these codes. Any questions
regarding these claims should be directed to the Unisys Point of Sale
helpdesk at (225) 216-6381 or 1-800-648-0790.
ATTENTION DENTAL PROVIDERS
The dental claims adjustment and recycle related
the dental rate increases that were effective 11-01-07 will appear on
your remittance advice in the near future. Providers who bill their
usual and customary fee as required by Medicaid should receive payment
adjustments without taking further action. You may go to
www.lamedicaid.com for further details. Contact LSU Dental Medicaid unit
at 504-941-8206 or 1-866-263-6534 (toll-free) if you have any questions.
ADJUSTMENT OF CIRCUMCISION CLAIMS
System changes have been made to correct age
editing associated with CPT code 54150 for circumcisions. Claims that
incorrectly denied for age restriction (error 234) beginning with DOS
01-01-07 have been systematically adjusted which are included in the
06-24-08 remittance. For further questions, contact Unisys Provider
Relations at 1-800-473-2783.
The university of Louisiana at Monroe
(ULM), pharmacy prior authorization office is moving during the weekend
of July 18. They will resume business on Monday, July 21, 2008. During
this time, the prior authorization edits of 485 and 486 will be
PROFESSIONAL SERVICES AND RHC/FQHC
Effective with dos 10-21-07, Louisiana Medicaid
reimburses for select adjunct services (currently CPT codes
99050-99051). Providers are responsible for adherence to the 'adjunct
services policy,' which is located on www.lamedicaid.com under 'New
Medicaid information' as well as in the 'Louisiana provider update.'
professional services providers may now submit claims for these
rhc/fqhc providers may begin submitting claims to
preserve timely filing, but should initially expect denials until
programming is finished. RHC/FQHC claims that deny due to this issue
will be systematically adjusted once programming is complete, and
providers should monitor future RA's for further information.
ATTENTION PROVIDERS OF NEWBORN
CARE: CPT CODE 99436
CPT code 99436, "attendance at delivery...
Stabilization of newborn," Has been made payable effective with dos
06-01-08. Any policies directing providers to use other CPT codes for
this service are no longer in effect. Providers are to follow CPT
guidelines regarding which services may or may not be reported in
addition to this code.
ATTENTION PROFESSIONAL SERVICES PROVIDERS: 2008 RATE CHANGES
Based on funding appropriated in the 2007
legislative session and approval by CMS, effective with DOS on or after
January 1, 2008, reimbursement rate changes for selected physician
services have been implemented on our pricing file. The first remittance
on which providers may see the new rates applied to claims is June 30,
2008. Please monitor the Medicaid website and RA messages in the near
future for more general information, updated fee schedules, and
information on systematic adjustments of claims paid at the previous
ATTENTION KIDMED CLINICS AND SCHOOL BASED HEALTH CENTERS
We are pleased to announce that all providers of
KIDMED services, including KIDMED clinics and school based health
centers, may now access their RS-0-07 reports electronically on the
secure side of the LA Medicaid website, www.lamedicaid.com, link ->
CommunityCare and/or KIDMED roster of enrollees. These reports are
loaded to the web site monthly and remain on the site for 2 months to
allow providers to access the current and the previous months' reports.
The reports are also downloadable to allow providers to save them in
your office system if you have a need to maintain more than the most
recent 2 months of data. Effective 07-01-08, hard copy reports will no
longer be mailed to you, and requests for reports to be reprinted hard
copy will not be honored. Please ensure that you have procedures in
place to retrieve these reports as needed.
DELAY OF DENIAL EDITS FOR NDC ON
PHYSICIAN ADMINISTERED DRUGS
Initially, with date of processing July 1, 2008,
claims submitted without the required, accurate NDC information for
Physician Administered Drugs were to deny. Currently, providers are
receiving educational edits for claims that do not contain this
information. The department has received concerns and issues from large
providers experiencing difficulty in preparing their systems to submit
these claims with the required information. As a result, the decision
has been to delay the implementation of denials for the NDC educational
edits until further notice. Please monitor the website and RA messages
for updated info.