RA Messages for August 26, 2008


If you are unsure about the coverage of a drug product, please contact the PBM help desk at 1-800-648-0790.


DRUG                                                         DOSE                    STRGTH                 FUL                 EFF
ALENDRONATE                                     TABLET                     35MG                15.36750         08/20/08
ALENDRONATE                                     TABLET                     70MG                15.36750         08/20/08
BALSALAZIDE DISODIUM                   CAPSULE                 750MG                1.07960           08/20/08
BENZONATATE                                     CAPSULE                 200MG                0.63380           08/20/08
BUPROPION HCL                                  TABLET SA              150MG                1.83300           08/20/08
CARVEDILOL                                         TABLET                   3.125MG              0.14250          08/20/08
CARVEDILOL                                         TABLET                   6.25MG                0.14250          08/20/08
CARVEDILOL                                         TABLET                   12.5MG                0.14250          08/20/08
CARVEDILOL                                         TABLET                   25MG                   0.14250          08/20/08
DICLOFENAC SODIUM                        DROPS                       0.1%                   4.27200          08/20/08
ONDANSETRON HCL                           TABLET                     4MG                   1.10000           08/20/08
ONDANSETRON HCL                           TABLET                     8MG                   1.90000           08/20/08
OXYCODONE HCL                                TAB SR. 12H            10MG                 OFF MAC       08/08/08
OXYCODONE HCL                                TAB SR. 12H            20MG                 OFF MAC       08/08/08
OXYCODONE HCL                                TAB SR. 12H            40MG                 OFF MAC       08/08/08
OXYCODONE HCL                                TAB SR. 12H            80MG                 OFF MAC       08/08/08
PRAVASTATIN SODIUM                       TABLET                    80MG                OFF MAC       08/20/08
PREDNISOLONE SOD PHOSPHATE    SOLUTION              15MG/5ML         0.20890          08/20/08
PROPRANOLOL HCL                            CAP.SA 24H              80MG                 1.54470          08/20/08
PROPRANOLOL HCL                            CAP.SA 24H             120MG                1.91600          08/20/08
PROPRANOLOL HCL                            CAP.SA 24H             160MG                2.50880          08/20/08
RANITIDINE HCL                                   SYRUP                     15MG/ML            0.40270          08/20/08
ROPINIROLE HCL                                  TABLET                    1MG                    0.75150          08/20/08
ROPINIROLE HCL                                  TABLET                    2MG                    0.75150          08/20/08
ROPINIROLE HCL                                  TABLET                    3MG                    0.77960          08/20/08
ROPINIROLE HCL                                  TABLET                    4MG                    0.77960          08/20/08
SERTALINE HCL                                    TABLET                    25MG                  0.12830          08/20/08
SERTALINE HCL                                    TABLET                    50MG                  0.12830          08/20/08
SERTALINE HCL                                    TABLET                    100MG                0.12830          08/20/08
TRANDOLAPRIL                                    TABLET                    1MG                    0.66660          08/20/08
TRANDOLAPRIL                                    TABLET                    2MG                    0.66660          08/20/08
TRANDOLAPRIL                                    TABLET                    4MG                    0.66660          08/20/08
ZALEPLON                                              CAPSULE                5MG                    0.71910          08/20/08
ZALEPLON                                              CAPSULE                10MG                  0.73860          08/20/08
ZOLPIDEM TARTRATE                          TABLET                    5MG                   0.07040          08/20/08
ZOLPIDEM TARTRATE                          TABLET                    10MG                 0.07040          08/20/08

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 A, available at www.lamedicaid.com.


Take charge Louisiana family planning waiver program Louisiana Medicaid has updated and corrected the reimbursement policy that applies to take charge family planning waiver participants for outpatient ambulatory surgery hospital billing (revenue code 490). Claims submitted prior to the correction of the system logic for take charge were paid billed charges instead of the appropriate rate for the procedure or may have received an inappropriate denial. The outpatient hospital ambulatory surgery claims (revenue code 490) submitted for participants in the take charge program will be recycled.

Please note that the only codes payable in combination with hr 490 (outpatient ambulatory surgery) for take charge participants are 58301, 58600, 58615, 58670, 58671. Any HCPCS other than these will deny when billed in combination with hr 490.


La Medicaid now accepts electronic transmission of TPL claims that must be submitted for payment. Providers must submit these claims using the correct 837 transaction. Providers are responsible for entering all required, appropriate and accurate information from the primary carrier EOB in the correct loops/ segments of the transaction. The correct 6-digit TPL carrier code is also required. Providers should notify and coordinate with their vendors if necessary to allow transmission of this additional information in the claims transactions. Providers/ vendors should use the 837 national specifications in conjunction with the la Medicaid EDI companion guide(s) to ensure that all information is entered correctly. This change will allow more efficient processing and payment of TPL claims. Please contact the Unisys EDI department (225-216-6303) to test claim files or for other EDI-related assistance. At a future date to be determined by DHH, TPL claims submitted hard copy that are not accompanied by a true and complete EOB from the primary carrier will be rejected. In the future, other providers will be allowed to bill these claims electronically.