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


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 ELIGIBILITY CARD

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 Hospitals.