RA Messages for
November 17, 2011
PHARMACY
PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
at 1-800-648-0790.
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.
LAPOST DOCUMENT TO AID IN END-OF-LIFE CARE
PLANNING
Baton Rouge, La. - The LaPOST document, recently
given final approval by the Louisiana Legislature, is now available as a
physician resource when helping patients plan and state their
end-of-life treatment preferences and goals of care. LaPOST, which
stands for Louisiana Physician Order for Scope of Treatment, specifies
patients' wishes in the event they are unable to communicate. It is a
physician order and is only recommended for patients with a
life-limiting illness and a life expectancy of less than one year.
Physicians and their patients must complete and sign the LaPOST document
for it to be valid. More information is available at
www.lhcqf.org.
COMMUNITY CHOICES WAIVER PERSONAL ASSISTANCE
SERVICES CLAIMS DENIALS
Claims for some Community Choices Waiver services
were denied in error. Logic has been put in place and claims are being
recycled. You do not have to resubmit.
ATTENTION PROFESSIONAL SERVICE PROVIDERS
ANESTHESIA POLICY
Louisiana Medicaid has received multiple inquiries
related to the
denied reimbursement of claims specific to Pain Management. Louisiana
Medicaid Pain Management policy states:
"Epidurals administered for the prevention or control of acute pain,
such as that which occurs during delivery or surgery, are covered by
the Professional Services Program for this purpose only. Epidurals
given to alleviate chronic, intractable pain are not covered."
Therefore, epidurals or nerve block anesthesia administered to a
recipient following a surgical related procedure for the prevention
on management of postoperative pain will not be reimbursed.
ATTENTION ALL PROVIDERS - MODIFIED PAYMENT
SCHEDULE
REMINDER: As you are aware, the Department is
increasing the Medicaid services' claims review time by adding an
additional 14 days to help root out fraud and abuse, as well as improve
the integrity of claims payment. To allow providers time to alter their
business practices and adjust to the modified payment schedule, the
Department opted to phase in this policy by adjusting payment dates back
one or two working days at a time in most months. Please remember to
check the modified payment schedule located at
www.lamedicaid.com/provweb1/recent_policy/2012_Medicaid_Checkwrite_Calendar.pdf.