RA Messages for
January 11, 2011
PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
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
for dates of service on or after January 1, 2011, the dental procedure
code D0272 will be reimbursable by Medicaid in the Early Periodic
Screening, Diagnosis, and Treatment (EPSDT) Dental Program only once a
year. Complete details can be located on the www.lamedicaid.com website
under the "Dental Providers" link. Contact the LSU Dental Medicaid Unit
at 504-941-8206 or 1-866-263-6534 (toll-free) with any questions.
HOSPITAL PROVIDERS: REIMBURSEMENT OF VAGUS
June 14, 2010, a PA-01 Form is no longer required for hospital providers
for the VNS device. However, reimbursement of the device continues to be
dependent upon approval of the surgeon to perform the procedure.
Hospitals should confirm that the surgeon has received an authorization
for the procedure prior to submitting their claim in order to prevent
The hospital will bill their VNS claim using HCPCS procedure
code C1767 (VNS generator) and/or C1778 (VNS leads) to Molina on a CMS
1500 claim form with the words DME written in red on the top of the form
and the PA number written in Item 23 or through the electronic claims
The claim will pend to the Molina Medical Review Department
for review of the surgeon's approved PA request. If approved, the
hospital claim will be allowed to process for payment; if there is no
valid authorization, the hospital claim will deny with edit 191 (PA
If the recipient is Chisholm, the authorization for the
device will be referred to PAL to assist the recipient in obtaining the
necessary documentation to process the request. This may include
identifying the surgeon to contact in order to assist with the
submission of his/her prior authorization request.
PROVIDERS (EXCEPT ATYPICAL)
to comply with federal requirements to include the National Provider
Identifier (NPI) on all claims. Changes to current claims processing
will be made over the next two months. Providers using the Molina Form
213 for Physician Crossover Adjustments, Professional Crossover
Adjustments, Durable Medical Equipment Adjustments, Durable Medical
Equipment TPL Adjustments, and Physician Adjustments will need to begin
using the CMS-1500 claim form; providers using the Rehabilitation forms
for claims and adjustments (102, 202) will instead be required to use
the CMS-1500 form. Over the coming months, changes to Dental (209, 210),
Pharmacy (211), and KIDMED (KM-3) claim forms will also be introduced to
accommodate these federal requirements. Providers who have software
vendors must alert their vendors of the changes. Please monitor the
Louisiana Medicaid website, www.lamedicaid.com, for an implementation
schedule and more details.
ADULT DAY HEALTH CARE WAIVER PROVIDER MANUAL
The Medicaid Adult
Day Health Care Waiver Provider Manual has been posted to the Louisiana Medicaid
Provider Support Center website (http://www.lamedicaid.com). It has an issue
date of December 1, 2010. You can click on the following link to go directly to
http://www.lamedicaid.com/provweb1/Providermanuals/ADHC/ADHC.pdf This direct
link to the ADHC Waver manual will be posted to the OAAS internet website as is the case for both the EDA Waiver and LT-PCS Provider
PROFESSIONAL SERVICES PROVIDERS
PEDIATRIC CRITICAL CARE CODES OMITTED FROM 9/22 & 10/6 CLAIM ADJUSTMENTS
It has come to our
attention that some claims for pediatric critical care codes were omitted from
the systematic budget adjustments that occurred on the 9/22/10 and 10/6/10 RA's.
Please note that the fees for these codes were implemented correctly and have
been reimbursing appropriately since that time. Claims that required adjustment
due to delayed implementation of the fee changes were not performed
systematically. Providers wishing to adjust their claims can do so on an
individual basis. Please contact Molina Provider Relations at (800) 473-2783 or
(225) 924-5040 with questions concerning this issue and for assistance with
adjustment of claims if needed.
2011 HCPCS UPDATE
is in the process of completing the programming for the 2011 HCPCS updates. This
includes both new and deleted codes for 2011. Every attempt is being made to
have the new codes/updates on file by mid January 2011. Please note that all
appropriate editing and coverage determinations for the new codes may not be
final at that time and adjustments to claims processed may be necessary.
Providers should monitor future RA messages.
ATTENTION PROFESSIONAL SERVICES PROVIDERS
PROCEDURE CODES PAYABLE TO OPTOMETRISTS
The Department recently updated programming logic for procedure codes payable
to optometrists effective for dates of service Jan 1, 2007 forward. Claims that
previously denied with errors 210 �PROVIDER NOT CERTIFIED FOR THIS PROCEDURE�,
298 �INVALID PROCEDURE CODE FOR DATE OF SERVICE� AND 299 �PROC/DRUG NOT COVERED
BY MEDICAID� were systematically adjusted on the RA of Dec 21, 2010.
As a result of
this update, claims for eyeglasses (V codes) inadvertently denied on the RA�s of
12/14/10, 12/21/10, 12/28/10, 1/4/11, and
1/11/11. We are working to repair this issue so that claims should
process correctly on the RA of
1/18/11. Claims that previously denied
due to this issue will be systematically adjusted on the RA of
1/18/11. Continue to monitor
www.lamedicaid.com and weekly RAs for further updates. Please contact the
Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions
concerning this issue.
Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225)
924-5040 should you have any questions related to the implementation of
the rate reductions in any of the previous messages.