RA Messages for November 24, 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.
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
PROVIDERS OF HOSPICE SERVICES
recipient revokes or is discharged alive during an election period, the
recipient loses any remaining days in the election period. Louisiana
Register Vol. 28, No. 26, June 20, 2002, Chapter 35, Section 3501-F.
It is the
intent of LA Medicaid to employ nationally recognized methods to improve
claims processing accuracy and consistency. With that goal in mind, LA
Medicaid is pleased to announce the planned implementation of the
McKesson 'ClaimCheck' claims editing product and the provider reference
tool known as 'Clear Claim Connection'. These products will supplement
our current claims processing system, especially as related to
professional and outpatient hospital claims. Preparations for this
implementation are underway with an anticipated effective date of
processing claims using 'ClaimCheck' of mid-May 2010. Please visit the
LA Medicaid web site, www.lamedicaid.com, using the 'ClaimCheck' link to
view the intial web notice and for ongoing updates on this project.
to the Pharmacy Benefits Management Services Manual are now available on
the Louisiana Medicaid website at www.lamedicaid.com. Pharmacy providers
should refer to the manual for a complete description of Medicaid
pharmacy program policy.
& RADIOLOGY (NON-HOSPITAL) PROVIDERS
IMPLEMENTATION OF REIMBURSEMENT RATE REDUCTIONS
with dates of service on or after August 4, 2009, the reimbursement
rates for laboratory and radiology services are reduced by 4.7% of the
fee amounts on file as of August 3, 2009. An emergency rule regarding
these reductions was published in the August 20, 2009, issue of the
Louisiana Register. Please refer to the emergency rule section of the
August 2009 Louisiana Register on the Office of the State Register's
website at http://doa.louisiana.gov/osr/. Providers will begin seeing
these reductions on the RA of December 8, 2009. For fees in effect for
date of service August 4, 2009, and forward, providers should refer to
the interim fee schedule posted on the homepage of the LA Medicaid
website (www.lamedicaid.com) under the link entitled "Lab & Radiology
(Non-Hospital) Rate Reductions" and not the Professional Services fee
schedule. Claims for date of service August 4, 2009, that were
adjudicated prior to December 8, 2009, will be systematically adjusted
and no action is required by providers. Providers should monitor future
RAs for updates regarding these adjustments. Notification will be made
via remittance advice message when the recycle occurs.