RA Messages for November 17, 2009


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

Detailed LMAC and FUL changes are posted on www.lamedicaid.com.

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

Griseofulvin Suspension will no longer require prior authorization effective November 5, 2009. The Preferred Drug List (PDL) will be updated on www.lamedicaid.com.

Attention Pharmacists and Prescribing Providers:

Prescriptions for asenapine(Saphris) and paliperidone (Invega Sustenna)  have been added to current DUR antipsychotic policy and:
 o will require appropriate ICD-9 diagnosis codes.
 o will deny when a recipient has two active antipsychotic prescriptions on their file,
 o and will be screened for doses exceeding the maximum recommended dose.
 ! Generic Name       ! Brand Name              ! Maximum Dose per Day       !
 ! Asenapine             ! Saphris                      ! 20mg/day                              !
 ! Paliperidone           ! Invega Sustenna        ! 234mg/day                            !
 Additionally,prescriptions for guanfacine (Intuniv),modafinil(Provigil) and armodafinil(Nuvigil) will deny when a recipient has an active prescription on their file for any agent used to treat ADD/ADHD that was written by a different prescriber.
 Please refer to the LMPBM Provider Manual and POS User Guide found at  www,lamedicaid.com for more details regarding these policies and claim  submission.


The Louisiana Department of Health and Hospitals has created EPSDT Dental Periodicity Schedule that will be available to providers via the www.lamedicaid.com website and the Provider Update Newsletter.


Some claims for Reassessments (H0031-52) that were submitted after the MHR service limits were implemented in the system on 8/24/09 were inappropriately denied for error code 901 (exceeded the allowable number of units). The programming has been corrected and all claims that were incorrectly denied are being recycled and will appear on your 11/10/09 remittance advice. Any recycled claims still denied are due to other errors with the claim. Please note the revised error code in these cases. No provider action is necessary.


Louisiana Medicaid has identified that some claims for the H1N1 influenza vaccine denied incorrectly on the 11/03/09 RA for edits 675 (Vaccine/Administration Conflict) and 676 (Primary Code Denied). This has been corrected and claim lines that erroneously denied for these edits will be systematically recycled on the RA of 11/10/09 and no action is required by providers. However, some claims submitted by providers with incorrect administration and/or vaccine codes were correctly denied for edit 675 and/or 676. These claims must be corrected and resubmitted by the provider in order to be considered for payment. After the recycle of 11/10/09, please review your RAs to determine which claims you must resubmit which may include claims for immunizations other than H1N1 influenza claims. For H1N1 influenza vaccines, the only acceptable code combination for billing is 90470 with 90663. Please contact Provider Relations at (800) 473-2783 if you have any questions.


Visit the OAAS website at http://www.oaas.dhh.louisiana.gov to view the OAAS Assessment, Care Planning and Service Delivery Publications.


Louisiana Medicaid has completed additional revisions to the KIDMED series of RS-O-07 screening reports to better reflect the status of KIDMED screenings for recipients linked to providers. These new reports will be posted for December 2009. Please review the web notice posted on the homepage of the La Medicaid website, www.lamedicaid.com, for details. Additionally, screenings that were not previously posted on the current RS-O-07 reports are reflected on the newly revised reports. With the exception of RHC/FQHC KIDMED encounters, only PAID screenings are and will be posted to these reports. As only paid KIDMED screening claims are incorporated on the RS-O-07 reports, if screening claims are denied, providers should make necessary corrections and resubmit the claims for payment. Contact Unisys Provider Relations at (800) 473-2783 with any questions.