RA Messages for
January 18, 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
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.
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.
ATTENTION PHYSICIANS AND INPATIENT
Louisiana Medicaid is pleased to announce the implementation of the
application Precert Inquiry. This web-based tool gives providers the
ability to electronically check the status of inpatient hospital
precertifications of Medicaid members. The ability to track the status
of these requests online will create more efficient processes for
providers and the Fiscal Intermediary.
This tool will be available to all inpatient hospitals and physician
providers on January 18, 2011. The Precert Inquiry application is
accessible through the secure Provider Login area at the Louisiana
Medicaid website, www.lamedicaid.com.
For further information regarding this web-based tool, please visit
www.lamedicaid.com. Click on "Forms/Files/User Manuals" on the left
side of the homepage, then click on User Manuals and this will bring
you to the link for the Precert Inquiry User Manual.
The provider rate reductions which were effective December 1, 2010,
have been rescinded and replaced with comparable rate reductions that
are effective January 1, 2011. These rate reductions have been
implemented through Emergency Rules that were published in order for
the state to avoid a budget deficit in the current fiscal year. For
details regarding which services are affected by these reductions,
please visit the Emergency Rule section of the Office of the State
http://doa.louisiana.gov/osr/. A summary of the
January 2011 rate reductions can also be accessed on the Louisiana
Medicaid website at www.lamedicaid.com.
DHH is currently working on programming to recycle claims that were
paid for dates of service from December 1-31, 2010. Providers should
monitor their weekly RA messages to determine when the particular
services which they deliver will be systematically adjusted.
ATTENTION ALL PROVIDERS WHO PERFORM
THAT REQUIRE PRIOR AUTHORIZATION
On 9/1/10, a claims processing problem occurred that allowed some
claims that require prior authorization (PA) to process and pay
without verifying the required prior authorization during the payment
cycle. The problem was identified and corrected. However, approximately
1,550 claims for providers whose services require prior authorization
were processed without authorization validation prior to the
correction of the problem. These claims that were paid without
authorization validation will be voided on the RA of 1/18/11. The
claims will then be recycled and reprocessed with the appropriate
authorization validity checks on the RA of 2/1/11. When recycled, some
of these claims may pend or deny if the service authorization is not
in place to allow payment of the claims. In these cases, providers
should review the pend or denial edit and take corrective action as
indicated in order to have the service considered for payment. We
apologize for any inconvenience caused by this error. Please contact
Molina Provider Relations at the number below should you have any
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.