Pharmacies are exempt from DME accreditation requirements until January 2011. After that time, the new health care reform law requires that CMS provide an exemption from accreditation to pharmacies who Medicare DME billings average no greater than 5% of total pharmacy sales, have had a Medicare billing number in good standing for the last 5 years, and agree to provide certain documentation to prove they meet these criteria. A reading of the law would imply that pharmacies open fewer than 5 years and new pharmacies are not eligible for an exemption.  Pharmacies that are currently accredited would not have to get reaccredited if they meet these criteria. We will be working with CMS to make sure that the new law is implemented consistent with Congress intent. Current law still requires DME suppliers to have a surety bond.

Some unaccredited pharmacies may have already stepped down from selling DME. Other may have voluntarily terminated. If you wish to now get back into the program, CMS has provided us with the following instructions:

1. Pharmacies that have "stepped down" MUST immediately amend their National Supplier Clearinghouse (NSC) Medicare Enrolment Application, 855s and "step up" (select the DMEPOS including diabetes supplies as described in 1C they wish to dispense). It may take up to 90 days for NSC to approve the amendments.

Complete Sections 1C, 2 (complete 2A1 and those data elements that are changing), 3, 13, and either 15 (if you are the authorized official) or 16 (if you are the delegated official), and 6 for the signer if that authorized or delegated official has not been established for this DMEPOS supplier.

2. If you have voluntarily terminated then you must complete all sections of the 855s. To activate once again may take longer than 90 days because the pharmacy must be re-inspected by the NSC to assure that the 25 NSC supplier standards are being met.

If you are reactivating your Medicare supplier billing number, complete all sections

3. Send in your 855s application registered mail or by other tracking carrier to the physical address below.

Overnight Mailing Address

National Supplier Clearinghouse

Palmetto, GBA* AG-495

2300 Springdale Drive, Bldg. 1

Camden, SC 29020

http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/DurableMedicalEquip.pdf

http://www.cms.hhs.gov/cmsforms/downloads/cms855s.pdf

IMPORTANT INFORMATION FOR MEDICAID PROVIDERS

IDENTIFYING OIL-SPILL RELATED ILLNESSES/INJURIES

FOR MEDICAID RECIPIENTS

DHH is implementing claims billing indicators to be used to identify services provided to Louisiana Medicaid recipients when treated for an oil spill-related illness or injury. This information is necessary to track and evaluate health outcomes and costs related to the BP Oil Spill.

Effective immediately, providers are asked to use the following indicators on applicable claims submitted to Louisiana Medicaid for processing and payment:

EDI 837P Transaction for Professional Services - Enter modifier U9 (Disaster Related Service or Illness) with all appropriate procedure codes. This modifier should follow any other modifiers currently required for claims payment.

CMS-1500 Claim Form - Enter modifier U9 (Disaster Related Service or Illness) with all appropriate procedure codes. This modifier should follow any other modifiers currently required for claims payment.

EDI 837I Transaction for Institutional Services - Enter the Condition Code DR (Disaster Related Service or Illness) as the first Condition Code with all appropriate services.

UB-04 Claim Form - Enter the Condition Code DR (Disaster Related Service or Illness) as the first Condition Code with all appropriate services.

Pharmacy POS Transactions - Enter the NCPDP Field Reason for Service Code (Data Element 439-E4) valid value "RE" (Suspected Environmental Risk) with all appropriate services.

Providers should begin immediately using these indicators on claims submitted for Medicaid payment. Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 with any related questions.

Use this .PDF to submit complaints to the Louisiana Department of Insurance. NOTE: LIPA can assist you in submitting the complaint forms, but the information must come from you.