RA Messages for October 21, 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 A:

DRUG                                                 DOSE                     STRGTH                 FUL                     EFF
Amlodipine Besylate                             Tablet                         2.5mg                 0.1290                11/06/08
Amlodipine Besylate                             Tablet                         5mg                    0.1290                11/06/08
Amlodipine Besylate                             Tablet                         10mg                  0.1782                11/06/08
Azathioprine                                         Tablet                         50mg                  0.6581                11/06/08
Azithromycin                                        Tablet                         250mg                 3.1875                11/06/08
Azithromycin                                        Tablet                         500mg                 5.4850                11/06/08
Azithromycin                                        Tablet                         600mg                 6.9080                11/06/08
Bisoprolol Fumarate                             Tablet                         5mg                     1.0688                11/06/08
Bisoprolol Fumarate                             Tablet                         10mg                   1.0688                11/06/08
Bupropion HCL                                   SA Tablet 12HR         150mg                1.8330                 11/06/08
Cefdinir                                                Capsule                      300mg                 3.8265                 11/06/08
Cefdinir                                                Oral Susp                   125mg/5ml           0.6231                11/06/08
Cefdinir                                                Oral Susp                   250mg/5ml           1.3079                11/06/08
Cefprozil                                              Tablet                         250mg                 2.3939                 11/06/08
Cefprozil                                              Tablet                         500mg                 4.5990                 11/06/08
Ciclopirox Olamine                              Top Susp                    0.77%                 1.5000                 11/06/08
Clindamycin HCL                                Capsule                       300mg                 2.0263                11/06/08
Divalproex Sodium                              Tablet DR                   125mg                  0.2691                11/06/08
Divalproex Sodium                              Tablet DR                   250mg                  0.5288                11/06/08
Divalproex Sodium                              Tablet DR                   500mg                  0.9749                11/06/08
Fexofenadine HCL                              Tablet                         30mg                    0.5756                11/06/08
Fexofenadine HCL                              Tablet                         60mg                    1.1540                11/06/08
Fexofenadine HCL                              Tablet                         180mg                  2.0018                11/06/08
Finasteride                                          Tablet                         5mg                       1.7303                11/06/08
Fosinopril Sodium                               Tablet                         10mg                     0.5980                11/16/08
Fosinopril Sodium                               Tablet                         20mg                     0.5980                11/16/08
Fosinopril Sodium                               Tablet                         40mg                     0.5980                11/16/08
Metronidazole                                     Top Gel                      0.75%                   1.5417                11/06/08
Midodrine                                          Tablet                          2.5mg                    1.1172                11/06/08
Midodrine                                          Tablet                          5mg                       1.8383                11/06/08
Midodrine                                          Tablet                          10mg                     3.1338                11/06/08
Promthazine HCL                              Tablet                          12.5mg                   0.4500                11/06/08
Quinapril Base                                   Tablet                          5mg                       0.2500                 11/06/08
Quinapril Base                                   Tablet                          10mg                     0.2500                 11/06/08
Quinapril Base                                   Tablet                          20mg                     0.2500                 11/06/08
Quinapril Base                                   Tablet                          40mg                     0.2500                 11/06/08
Ramipril                                             Capsule                       1.25mg                  0.4590                 11/06/08
Ramipril                                             Capsule                       2.50mg                  0.4877                 11/06/08
Ramipril                                             Capsule                       5mg                       0.5117                 11/06/08
Ramipril                                             Capsule                       10mg                     0.5987                 11/06/08
Simvastatin                                        Tablet                           5mg                      0.1750                 11/06/08
Simvastatin                                        Tablet                           10mg                    0.1750                 11/06/08
Simvastatin                                        Tablet                           20mg                    0.2100                 11/06/08
Simvastatin                                        Tablet                           40mg                    0.2555                 11/06/08
Simvastatin                                        Tablet                           80mg                    0.2555                 11/06/08
Terbinafine HCL                                Tablet                          250mg                  0.7050                 11/06/08
Theophylline Anhydrous                     Tablet SR                    100mg                  0.1971                 11/06/08
Torsemide                                         Tablet                          5mg                       0.4500                 11/06/08
Torsemide                                         Tablet                          10mg                    0.4800                  11/06/08
Torsemide                                         Tablet                          20mg                    0.5250                  11/06/08

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.


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.


LMACs have been removed from products which are now provided by a single manufacturer unless a Federal Upper Limit is in place. Providers should refer to APPENDIX A found at www.lamedicaid.com. The effective date of these changes is October 15, 2008. Please file adjustments for claims that may have been incorrectly paid.


Effective for dates of service October 1, 2008, forward, claims processing edits that were lifted as a result of Hurricane Gustav as posted on the web site, www.lamedicaid.com, will be reinstated. All providers should begin following normal procedures for servicing and billing for LA Medicaid recipients. CommunityCARE/KIDMED auto-assignments will resume with linkages for October 2008. Emergency provider enrollment procedures will be rescended at that time, also. Questions regarding these procedures may be directed to Unisys Provider Relations at (800) 473-2783 or (225) 924-5040.


HMS, DHH's TPL contractor, has developed an automated application (Provider Portal) for providers to use in conjunction with recoupment projects (i.e., commercial insurance and Medicare projects). The application has also been customized to notify providers of claims paid by carriers to DHH as a result of HMS billings so that providers can submit claims directly to insurance carriers in accordance with Act 517 of the 2008 Louisiana Statutes. Each provider must contact HMS to enroll in the Provider Portal.

Please contact Ms. Amy Parks of HMS at 214-453-3132 or via email at aparks@hms.com to complete your enrollment application. We hope you will take advantage of this automated system. Thank you.

CURRENT CPT CODES 99148, 99149 and 99150

Effective January 1, 2008, Louisiana Medicaid will reimburse for moderate sedation services provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports. Providers are responsible for adherence to the updated "Pediatric Moderate (Conscious) Sedation" policy, which is located at www.lamedicaid.com under "New Information," and will be published in an upcoming "Louisiana Medicaid Provider Update."


System changes have been made to correct editing associated with primary and add-on codes for screening mammograms. Louisiana Medicaid policy allows payment of one screening mammogram per calendar year for females at least 40 years of age. The screening mammogram may consist of one primary procedure and one add-on procedure, each billed with HR403. For date of service January 1, 2007, and forward, allowable HCPC codes are 77057 (primary) and 77052 (add-on). For dates of service in 2006, allowable codes are 76092 (primary) and 76083 (add-on). Programming is now in place to allow these codes to pay correctly. A recycle of claims for dates of service January 1, 2006 - August 2, 2008, was recently completed and appeared on the September 30, 2008, remittance advice.


Please be advised that effective immediately, the department shall recognize procedure code S8189 for custom trach tube. A letter of medical necessity explaining why a custom trach tube is needed rather than a standard trach tube along with a cost invoice should be attached with each Prior Authorization (PA14) request.


The deadline for submitting retroactive claims for processing by LA Medicaid has been extended through November 30, 2008. Please ensure that all claims for the retroactive period for which you intend to submit claims are received by Unisys no later than November 30th. Beginning December 1, 2008, crossover claims must be filed in accordance with timely filing guidelines.