RA Messages for November 17, 2009
PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
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
Suspension will no longer require prior authorization effective November
5, 2009. The Preferred Drug List (PDL) will be updated on
Pharmacists and Prescribing Providers:
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
o and will be screened for doses exceeding the maximum recommended dose.
! Generic Name ! Brand Name
! Maximum Dose per Day !
! 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
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.
MENTAL HEALTH REHABILITATION (MHR) PROVIDERS
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.
PROVIDERS OF H1N1 FLU VACCINES (non-Pharmacy providers)
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.
ASSESSMENT, CARE PLANNING AND SERVICE DELIVERY PUBLICATION
OAAS website at http://www.oaas.dhh.louisiana.gov to view the OAAS
Assessment, Care Planning and Service Delivery Publications.
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