RA Messages for November 4, 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  

ALLOPURINOL                                  TABLET        100MG      $0.07850  11/28/08

ALLOPURINOL                                  TABLET        300MG      $0.17390  11/28/08

BACLOFEN                                         TABLET         10MG      $0.05250  11/28/08

BACLOFEN                                         TABLET         20MG      $0.08930  11/28/08

CAPTOPRIL                                        TABLET        12.5MG     $0.02330  11/28/08

CAPTOPRIL                                        TABLET         25MG      $0.02630  11/28/08

CHLORDIAZEPOXIDE HCL             CAPSULE         5MG      $0.11390  11/28/08

CHLORDIAZEPOXIDE HCL             CAPSULE        10MG      $0.08780  11/28/08

CHLORDIAZEPOXIDE HCL             CAPSULE        25MG      $0.09900  11/28/08

CIMETIDINE                                       TABLET        400MG      $0.15480  11/28/08

CLORAZEPATE DIPOTASSIUM      TABLET        3.75MG     $0.13770  11/28/08

CLORAZEPATE DIPOTASSIUM      TABLET         7.5MG     $0.19470  11/28/08

CLORAZEPATE DIPOTASSIUM      TABLET         15MG      $0.27540  11/28/08

DIPHENOXYLATE HCL/ATROP      TABLET     2.5MG-.025MG  $0.21380  11/28/08

ENALAPRIL MALEATE                    TABLET         2.5MG     $0.04730  11/28/08

ENALAPRIL MALEATE                    TABLET          5MG      $0.05700  11/28/08

ENALAPRIL MALEATE                    TABLET         10MG      $0.07320  11/28/08

ENALAPRIL MALEATE                    TABLET         20MG      $0.08550  11/28/08

FLUOCINONIDE                             CREAM(GM)     0.05%      $0.11870  11/28/08

FLUOCINONIDE                             SOLUTION      0.05%      $0.26400  11/28/08

FOLIC ACID                                       TABLET          1MG      $0.03780  11/28/08

GABAPENTIN                                   CAPSULE       100MG      $0.08250  11/28/08

GABAPENTIN                                   CAPSULE       300MG      $0.12380  11/28/08

GABAPENTIN                                   CAPSULE       400MG      $0.15180  11/28/08

HYDROCODONE BIT/ACET         SOLUTION    7.5-500/15   $.10140   11/28/08

HYDROCODONE BIT/ACET             TABLET       5MG-500MG   $0.47630  11/28/08

HYDROCODONE BIT/ACET             TABLET      7.5MG-500MG  $0.64260  11/28/08

HYDROCODONE BIT/ACET             TABLET       10MG-500MG  $0.51290  11/28/08

HYDROCODONE BIT/ACET             TABLET      7.5MG-650MG  $0.67080  11/28/08

HYDROCODONE BIT/ACET             TABLET       10MG-660MG  $0.54000  11/28/08

HYDROCODONE BIT/ACET             TABLET      7.5MG-750MG  $0.15480  11/28/08

ISOSORBIDE DINITRATE                 TABLET          5MG      $0.04880  11/28/08

ISOSORBIDE DINITRATE                 TABLET         10MG      $0.05250  11/28/08

ISOSORBIDE DINITRATE                 TABLET         20MG      $0.05630  11/28/08

LIDOCAINE HCL                            SOLUTION        2%       $0.05130  11/28/08

LISINOPRIL                                       TABLET         2.5MG     $0.03680  11/28/08

LISINOPRIL                                       TABLET          5MG      $0.04830  11/28/08

LISINOPRIL                                       TABLET         10MG      $0.06750  11/28/08

LISINOPRIL                                       TABLET         20MG      $0.07950  11/28/08

LISINOPRIL                                       TABLET         30MG      $0.16310  11/28/08

LISINOPRIL                                       TABLET         40MG      $0.15000  11/28/08

LORAZEPAM                                    TABLET        0.5MG      $0.07400  11/28/08

LORAZEPAM                                    TABLET         1MG       $0.08220  11/28/08

LORAZEPAM                                    TABLET         2MG       $0.14670  11/28/08

MECLIZINE HCL                                TABLET         25MG      $0.07790  11/28/08

METHOCARBAMOL                        TABLET        500MG      $0.19430  11/28/08

METHOCARBAMOL                        TABLET        750MG      $0.25200  11/28/08

METHYLPREDNISOLONE               TABLET         4MG       $0.43040  11/28/08

OXYCODONE HCL/ACET               CAPSULE      5MG-500MG   $0.32300  11/28/08

OXYCODONE HCL/ACET               TABLET       5MG-325MG   $0.23400  11/28/08

PAROXETINE HCL                           TABLET        10MG       $0.34250  11/28/08

PAROXETINE HCL                           TABLET        20MG       $0.35750  11/28/08

PAROXETINE HCL                           TABLET        30MG       $0.42000  11/28/08

PAROXETINE HCL                           TABLET        40MG       $0.48750  11/28/08


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 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.


Ciclopirox Suspension and Tolcapone (Tasmar) were listed incorrectly on the Preferred Drug List (PDL) effective November 1, 2008. The correct status is:

Ciclopirox Suspension - Preferred
Tolcapone (Tasmar) - Requires PA

Please reflect the noted changes on your copy of the PDL mailed October 20.


Effective with date of service October 1, 2007, LA Medicaid reimburses professional service providers for select CPT procedure codes specific to immunizations for influenza, pneumococcal, and human papillomavirus diseases for adult recipients ages 21 and older. The necessary logic changes are complete to allow these services to be paid. Claims that have been held may now be submitted. Providers that have claims that were not initially submitted and are now over the timely filing limit must coordinate submission of the claims with Unisys Provider Relations at (800) 473-2783. A systematic claims recycle of all denied claims will occur in the near future and providers will be notified of the details in upcoming RA messages. A detailed provider notice and a fee schedule of vaccine codes covered by LA Medicaid are located on the LA Medicaid web site, www.lamedicaid.com, links New Medicaid Information and Fee Schedules, respectively.


Some claims for procedure code T1019 with UB modifier were cut back erroneously, therefore these claims will be adjusted to allow payment for the correct number of units. The system adjustments will appear on your remittance dated 10/28/08.

There were also occurrences of claims with code T1019 that were paid without proper prior authorization information included. These claims will be voided on the remittance dated 10/28/08.


Updates to the Pharmacy Benefits Management Services Manual are now available on the Louisiana Medicaid web site at www.lamedicaid.com. Pharmacy providers should refer to the manual for a complete description of Medicaid pharmacy program policy.


Dental policy changes in regards to the EPSDT Dental codes D9230, D9248, and D9920 went into effect on October 7, 2008. Complete details are placed on the www.lamedicaid.com web site under the "New Medicaid Information" and "Billing Information" links. If you have questions, you may contact the LSU Dental Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free).


As a result of Hurricane Gustav we implemented logic to bypass various edits, including some service limit edits, for dates of service August 27th through September 30th. One of those edits, Edit 907 (Physician/Clinic Visits Exceeded) was not bypassed correctly for the affected dates of service. Claims that were denied because of this have been identified and will be recycled for correct payment in the 11/04/08 RA. No action is required by providers.


You were notified in the 2007 Louisiana Medicaid Hospital Provider Training packet that only 1 revenue code 450 or 459 may be used per emergency room visit. Providers have continued to inappropriately bill multiple revenue codes 450 and 459. As a result, programming logic has been implemented recently to deny claims billed with these multiple codes. One revenue code 450 or 459 (as appropriate) should be billed and should be accompanied by the correct, appropriate procedure code 99281-99285. Other procedure/HCPCS codes are inappropriate. Providers billing multiple codes 450 and 459 are now receiving denial edit 114 (invalid/ missing HCPCS) for lines displaying procedure codes other than 99281-99285, and denial edit 093 (revenue code missing/invalid) for the claim line displaying the correct procedure codes 99281-99285. The 093 denial code is being changed to reflect new denial code 113 (only 1 ER revenue 450-459 code per visit). It is necessary for any provider billing multiple ER revenue codes and receiving these details to resubmit the single, correct revenue code line with the correct procedure/HCPCS code for consideration of payment. Please discontinue this practice immediately!