RA Messages for September 30, 2008


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

Please note the following changes to Appendix B:

LABELER                         COMPANY                                      BEG                     END
14789             NEXUS PHARMACEUTICALS, INC.                                         10/01/08
17714             ADVANCE PHARMACEUTICALS, INC.                                   10/01/08
25021             SAGENT PHARMACEUTICALS, INC             01/01/09
38779             MEDISCA, INC                                                  01/01/09
42457             EMMAUS MEDICAL, INC.                               01/01/09
52555             MARTEC USA,LLC                                                                      10/01/08
58826             COATS ALOE INTERNATIONAL, INC.                                    10/01/08
58869             DARTMOUTH PHARMACEUTICALS, INC.                              10/01/08
59390             ALTAIRE PHARMACEUTICALS, INC.                                      10/01/08
60242             ADVENT PHARMACEUTICALS, INC.                                       10/01/08
65293             THE MEDICINES COMPANY                                                     10/01/08
66440             AERO PHARMACEUTICALS, INC.                                            10/01/08
66860             CURA PHARMACEUTICAL CO., INC.                                      10/01/08
68016             CHAIN DRUG CONSORTIUM, LLC             10/01/08

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 C, available at www.lamedicaid.com.


Important information related to the temporary easement of Medicaid claim edits due to hurricane Gustav is now posted on the LA Medicaid web site, www.lamedicaid.com. Use the �Disaster/ Important Notices� link to review this information. The information is also posted on the �Billing Information� link.


Several months ago, it was brought to our attention that Anesthesia Providers rendering services to Take Charge participants were paid incorrectly for procedure code 00851 (anesthesia for Tubal Ligation/ Transection). Necessary changes were made to pay this procedure code correctly for claims paid for dates of processing 04/29/08 and after. Incorrectly paid claims for dates of processing on or before 04/28/08 are being recycled on the 09/30/08 RA.


We have learned that a system problem occurred on outpatient claims processed in the checkwrites dated 09/02/08 and 09/09/08. This problem caused the Units and Billed Charge fields on these claims to be expanded by one digit, and the claims were priced and paid accordingly. We have corrected this error and will process systematic adjustments for the erroneously processed claims. No action is required on your part. The majority of these claims were overpaid which necessitates a recoupment from the provider. A few of the claims will be systematically adjusted to correct the incorrect Units or Billed charges only, and there will be no adjustment/ difference in the Medicaid paid amount for these claims. The systematic adjustments will be displayed in the Adjustment Claims/ Previously Paid Claims sections of your remittance advice dated 09/30/08. We apologize for any inconvenience this error may have caused. Contact Unisys Provider Relations at (800) 473-2783 or (225) 924-5040 if you have questions.