RA Messages for October 07, 2008
PHARMACY PROVIDERS, PLEASE
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:
NEXUS PHARMACEUTICALS, INC.
ADVANCE PHARMACEUTICALS, INC.
SAGENT PHARMACEUTICALS, INC
EMMAUS MEDICAL, INC.
COATS ALOE INTERNATIONAL, INC.
DARTMOUTH PHARMACEUTICALS, INC.
ALTAIRE PHARMACEUTICALS, INC.
ADVENT PHARMACEUTICALS, INC.
THE MEDICINES COMPANY
AERO PHARMACEUTICALS, INC.
CURA PHARMACEUTICAL CO., INC.
CHAIN DRUG CONSORTIUM, LLC
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
ATTENTION PHARMACISTS AND
The drug categories that
were reviewed at the August 13, 2008 P&T meeting will be implemented
into the PDL/PA process on November 1, 2008.
ATTENTION ALL PROVIDERS
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.
ATTENTION TAKE CHARGE FAMILY
PLANNING WAIVER- ANESTHESIA PROVIDERS
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.
ATTENTION HOSPICE, HEMODIALYSIS
AND HOSPITAL PROVIDERS
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