RA Messages for December 1, 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

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.


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.


When a 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.


Updates 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.


Effective 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.


The 2009 holiday EDI processing schedule will be as follows:

Thanksgiving Wed. Nov25 at 10:00AM
Christmas Wed. Dec23 at 10:00AM
New Year Thurs. Dec31 at 10:00AM

*NO extension will be given