RA Messages for October 6, 2009
PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
PLEASE NOTE THE
FOLLOWING CHANGES TO APPENDIX A
off MAC 09/25/09
Heparin Sodium, porcine vial
off MAC 09/09/09
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
for the August monthly CommunityCARE Management Fees that denied with
error 233 (Procedure Not covered) are being systematically recycled. You
will see the correct processing/payment of these claims on the 09/22/09
RA. No provider action is required.
PROVIDERS BILLING ELECTRONIC (EDI) CLAIMS
processing error occurred the week of 09/07/09 that caused some EDI
claim files to be dropped from the system. Claims contained on these
dropped files were not processed in the checkwrite of 09/15/09. We have
retrieved the dropped files and they are being processed in this week's
RA (09/22/09). We have received calls from some providers and vendors
this week concerning their claim files, and in some cases the files were
resubmitted either by the provider/vendor or by Unisys EDI. If your
files were resubmitted, you may see duplicate claims on the 09/22/09 RA
where these files are being retrieved and reprocessed as a part of this
corrective action. Please disregard the duplicate denials, and we
apologize for any inconvenience this has caused our providers and
vendors. Please contact the Unisys EDI Department at 225-216-6303 if you
have concerns once this corrective action is taken.
has designated the Louisiana Health Care Quality Forum (LHCQF) as the
entity responsible for guiding Louisiana's efforts to secure funding and
support for health information technology through the stimulus bill.
Funding is available to support health care providers through technical
assistance and loan programs to assist in financing HIT acquisitions.
Additionally, providers can receive Medicare or Medicaid incentives if
they meet the "meaningful use" criteria that will be determined this
The LHCQF is conducting a survey to gather necessary information to
inform all of its activities related to supporting providers in
Louisiana in meeting the incentive requirements and avoiding penalties
for not doing so. The current survey is for ambulatory health care
take a few minutes to complete the survey by using the following link:
The link may also be found on the LHCQF website at www.lhcqf.org. If you
do not have internet access but would like to complete the survey,
please call (225)334-9299.
Responses are needed by Friday, September 25, 2009.
PROFESSIONAL PROVIDERS OF VACCINATIONS
the continued public health issues related to influenza, the Department
of Health and Hospitals (DHH) has received many calls regarding the
availability of seasonal influenza vaccines for Medicaid children. We
have republished the policy related to the vaccine and its
administration on the homepage of the lamedicaid.com website for your
review and use. After reviewing the policy, if you have questions,
contact DHH, the Office of Public Health (OPH) Vaccines for Children (VFC)
Program, your local health unit, or Unisys Provider Relations as
to the Pharmacy Benefits Management Services Manual are now available on
the Louisiana Medicaid website at www.lamedicaid.com. Pharmacy providers
should refer to the manual for a complete description of Medicaid
pharmacy program policy.