PHARMACY PROVIDERS, PLEASE
If you are unsure about the coverage
of a drug product, please contact the PBM help desk at 1-800-648-0790.
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 http://www.lamedicaid.com/.
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
ATTENTION PROVIDERS: NON-THIRD PARTY LIABILITY RELATED CREDIT BALANCE AUDITS
Clarification of Credit Balance Audits
Effective January 1, 2014, Myers and Stauffer, LC will assume the responsibility for performing
non-TPL-related Credit Balance Audits (CBA) to identify excess Medicaid payments.
Please contact Myers and Stauffer at LA_RAC@mslc.com to set up a secure FTP account for
ATTENTION ALL PROVIDERS 2014 HCPCS UPDATE:
Louisiana Medicaid is currently in the process of completing the 2014 HCPCS update. The Louisiana Medicaid files have been updated to reflect the deleted HCPCS codes for 2014.
It is the Department's intent to have the new codes and updates on file as soon as possible including appropriate editing and coverage determination for the new 2014 HCPCS codes.
The Professional Services Fee Schedule and Outpatient Hospital Fee Schedules on the La Medicaid website, www.lamedicaid.com will be updated in the near future to reflect these changes.
Providers should monitor their RA messages for additional information.
Thank you for your assistance in this matter.
Urgent National Correct Coding Initiative Update:
Preventive Care Codes and Immunization Administration Codes
As stated in the October 2013 web notification: Effective 2014, states will no longer have CMS approval to deactivate the preventive care and immunization administration code pairs; for that reason, Louisiana Medicaid fee for service (legacy) and Bayou Health Plans must reactive these edits. CMS has provided the following guidance which shall allow both the immunization administration and the preventive medicine evaluation and management (E/M) service to be reimbursed.
"If a Medicaid beneficiary receives one or more immunizations and a "significant,
separately identifiable" preventive-medicine evaluation and management (E/M) service from the same provider
on the same date of service, the provider's Medicaid claim(s) should include both the immunization
administration code . . . and the comprehensive preventive-medicine E/M code . . . with modifier 25
appended . . . .
If the provider . . . bills a comprehensive preventive-medicine E/M code for the same
day and does not append modifier 25, the Medicaid PTP edits will deny payment of the preventive medicine E/M
Louisiana Medicaid fee for service (legacy) and Bayou Health Plans will reimburse both the immunization administration and the preventive medicine E/M services when modifier -25 is properly appended to the preventive medicine E/M procedure code. Documentation in the clinical record must substantiate each service.
For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 of (225) 924-5040.