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.