RA Messages for July 21, 2009
PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
Detailed LMAC and FUL
changes are posted on
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
HOSPITAL PROVIDERS OF OUTPATIENT SERVICES
Louisiana Medicaid is now accepting
Outpatient claims with procedure code 99291 (critical care) as one of
the acceptable codes (along with 99281-99285) that can be billed with
Revenue codes of HR450 or HR459. Outpatient claims that denied with this
procedure code previously will be recycled for Dates of Service 7/1/2008
to current. These claims should appear on the RA of 7/7/2009. No
provider action is necessary.
PROVIDERS SUBMITTING 837I TRANSACTIONS
You were recently notified of the
delay in requiring entry of the 10-digit National Provider Identifier (NPI)
as the CommunityCARE Primary Care Physician (PCP) Referral Authorization
Number on 837I electronic data interchange (EDI) claims transactions.
DHH is implementing new requirements for service providers who must
transmit the PCP Referral Authorization Number in 837I transaction.
Please review the provider notice found on the Louisiana Medicaid
website home page at www.lamedicaid.com for details of this change.