RA Messages for December 22, 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
CHANGES TO THE 148 PLI ADJUSTMENT PROCEDURE
December 1, 2009, all 148 PLI Adjustment Forms may only be completed and
submitted to Unisys for processing by a BHSF representative. Providers
may no longer complete and/or submit these forms for processing. The 148
PLI Adjustment Form is being revised to reflect these changes, and forms
may no longer be obtained through Unisys. Providers should contact the
recipient's Parish Medicaid Office if they have information or concerns
about patient liability.
NOTICE TO ALL MEDICAID PROVIDERS AND VENDORS
Due to a
shortage of Louisiana Medicaid 7-digit provider numbers to enroll new
providers, we will increase the availability of these numbers for
assignment to newly enrolled providers by using numbers that being with
"2" as the first digit of the number. Beginning December 4, 2009, LA
Medicaid will convert all systems to accept 7-digit provider numbers
beginning with "2". LA Medicaid provider numbers beginning with "1" will
continue to be valid and accepted. Please see the homepage at our
website, www.lamedicaid.com, for additional information and continue to
watch RA messages and the website for definite dates of this conversion.
LOUISIANA MEDICAID REIMBURSEMENT OF TAMIFLU� SUSPENSION
Medicaid does not pay for compounded prescriptions, nor has the billing
process been established to allow the submission of compounded
Due to H1N1 Declared Emergency and shortage of commercially manufactured
oseltamivir (Tamiflu�) suspension, Louisiana Medicaid will only allow
pharmacies to bill the quantity of Tamiflu� capsules utilized in the
mixing of the suspension as ordered by a prescribing practitioner's
prescription. This will be allowed as long as the shortage of the
manufactured Tamiflu� exists.
Pharmacies may receive letters from the Louisiana Medicaid Pharmacy
Audit Section which is verifying the quantity of Tamiflu� capsules
dispensed. In some instances, pharmacies have submitted billed
quantities for the final compounded quantity and not the total number of
capsules used in the mixing of the suspension. Following the
instructions above will avoid the overbilling of quantities and/or
When a pharmacy is attempting to bill Medicaid as the secondary payor,
the claim must be submitted on the NCPDP paper Universal Claim Form.
For those pharmacy providers who have a Memorandum of Understanding with
the Louisiana Department of Health and Hospitals' Office of Public
Health to dispense antivirals from the Strategic National Stockpile,
please be reminded that Medicaid may not be billed for these
PROVIDERS OF CHILDHOOD IMMUNIZATIONS
vaccine for the booster dose of children aged 15 months through 4 years
for the Haemophilus influenzae type b (Hib) immunization series is
available from the Vaccines for Children (VFC) Program. The American
Medical Association (AMA) has released guidelines for the use of the
Current Procedural Terminology (CPT) procedure code 90648 for reporting
the use of this Hib booster vaccine for the booster (final) dose of the
Hib immunization series (see CPT Assistant September 2009). Louisiana
Medicaid follows this guidance from the AMA and providers of childhood
vaccines should use CPT code 90648 for reporting this vaccine. If
nationally approved changes occur to CPT codes at a future date,
providers are to follow the most accurate coding available for covered
services, unless otherwise directed.
Medicaid will reimburse providers for the administration only of the
vaccine as the vaccine is available from the Louisiana VFC program at no
charge to VFC enrolled providers. Providers should contact the Unisys
Provider Relations unit at (800) 473-2783 or (225) 924-5040 with billing
policy questions. Questions related to this vaccine including its
availability should be directed to the Louisiana Office of Public
Health-Immunization Program at (504) 838-5300.
Nursing Home Case-Mix Rate Training Workshop is scheduled for January
25, 2010 from 1:00 p.m.- 4:30 p.m. at the Department of Environmental
Quality, Galvez Building, Oliver Pollock Conference Room C111, 602 N.
Fifth Street, Baton Rouge, LA 70802.
This program has been designed to provide nursing facility personnel and
consultants an understanding of the Louisiana case-mix rate methodology,
case-mix calculations, fair rental value bed-buy back, private room
conversions, and the use of cost report data.
The training is appropriate for Cost Report Preparers, Accountants
(including Home Office Staff), CFO's, Controllers, Office Managers, and
Others involved in Case-Mix Rate Reviews. 4 CPE credits: Specialized
Knowledge & Applications. Submit registration by January 18, 2010. To
download the registration form, go to http://www.dhh.la.gov/offices/events.asp?ID=111&detail=7910
or contact Myers & Stauffer LC @ 1-800-374-6858.
MULTI-SYSTEMIC THERAPY (MST) PROVIDERS
may now view the current MST Provider Manual on the Medicaid website,
LAMedicaid website now has a "Dental Providers" link on the left of the
homepage. This link provides information about the Medicaid Dental
programs and services available to Medicaid dental providers. The
website can be accessed at www.lamedicaid.com. Questions about the
LAMedicaid website may be directed to Unisys Provider Relations at (800)
473-2783 or (225) 924-5040.