PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
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
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.
DHH TO TRANSITION TO USING ONE TYPE OF
The Department of Health and Hospitals (DHH)
currently issues two types of plastic swipe medical eligibility cards
(MECs) for purposes of verifying Medicaid enrollment and service
coverage or restrictions. A pink MEC is issued to women eligible for the
TAKE CHARGE Family Planning Waiver which has a benefit package limited
to only family planning services, and a white MEC is issued to
individuals eligible for all other Medicaid eligibility programs.
Over the coming months, DHH will transition to the issuance of a white
MEC for all Medicaid eligibility programs regardless of the scope of the
benefit package. Therefore, it is important that providers verify
eligibility and coverage limitations or restrictions on the date of
service on all Medicaid enrollees by either logging in to the Louisiana
Medicaid Provider Support Center on www.lamedicaid.com, or calling the
Recipient Eligibility Verification System (REVS) at 1-800-776-6323.
Failure to do so may result in denied claims.
ATTENTION INPATIENT ACUTE HOSPITAL PROVIDERS
CHANGE IN RETROSPECTIVE REVIEW PROCESS
In November of 2010, DHH changed the requirements for
the retrospective review process for Acute Inpatient Hospital Providers.
Since then, DHH has monitored this process and listened to the
suggestions and concerns of the hospital providers. Beginning August 1,
2011, a new retrospective review process will be implemented. Please
visit the Medicaid website at www.lamedicaid.com to review the amended
process. Please note that this new process only applies to Acute
Inpatient Hospitals and does not apply to Psychiatric, LTAC, or Rehab