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 All Providers regarding Invalid Codes:
It has been brought to the attention of DHH that a few long standing invalid procedure codes were still listed on the
Professional Services fee schedule. This has been corrected and the invalid procedure codes, 99289, 99290, and 99436
have been made non-payable on all types of service and will no longer appear on the fee schedule once the next monthly
update is posted. Providers should refer to the Current Procedural Terminology (CPT) manual for the appropriate billing
codes and follow current CPT guidelines.
ATTENTION ALL PROVIDERS 2013 HCPCS UPDATE:
Louisiana Medicaid is currently in the process of completing the 2013 HCPCS update. The Louisiana Medicaid files have
been updated to reflect the deleted HCPCS codes for 2013. Every attempt is being made to have the new codes and updates
on file as soon as possible which includes appropriate editing and coverage determination for the new codes.
The Professional Services fee schedule on the La Medicaid website, http://www.lamedicaid.com/ will be updated in the near
future to reflect these changes. Providers should monitor their RA messages for additional information.
ATTENTION DENTAL PROVIDERS:
Effective for dates of service on and after January 1, 2013, procedure code and nomenclature changes will be reimbursable
by Medicaid in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Dental Program. Applicable policy and
reimbursement information will be located at http://www.lamedicaid.com/ under the "Dental Providers" link. If you do not have web access
and wish to request a hardcopy of the revised information and fee schedules, you should contact Molina Provider Relations as
soon as possible by calling (800) 473-2783.
Attention All Providers:
Billing Medicaid Recipients for Services
This message is to remind all providers that within your agreement of participation with Louisiana Medicaid you agree to accept
the Medicaid payment as payment in full for services rendered to Medicaid recipients, providing for the allowances for co-payments authorized by Medicaid.
A recipient may be billed for services that have been determined as non-covered or exceeding the services limit for recipients
over the age of 21. Recipients are also responsible for all services rendered after his/her eligibility has ended. Providers
may not bill recipients in instances where provider billing errors have caused a denied claim. In order to bill a recipient
for a non-covered service, the recipient must be informed both verbally and in writing that he/she will be responsible for payment of the services.
We also want to remind you that providers are not required to accept every recipient requesting service. However, when a provider
does accept a recipient, the provider cannot choose which services will be provided. The same services must be offered to a
Medicaid recipient as those offered to individuals not receiving Medicaid, provided the services are reimbursable by the Medicaid Program.
Providers must treat Medicaid recipients equally in terms of scope, quality, duration and method of delivery of
services (unless specifically limited by regulation).
Update to 'CiaimCheck' Product Editing - January 2013
'Clear Claim Connection' Information
McKesson's 'ClaimCheck' product, used in claims processing, is routinely updated by McKesson Corporation. The most recent update is based on changes
made to key industry mandates as well as enhanced modifier processing functionality. This update will affect claims processed beginning with
the remittance advice of January 22, 2013, forward. Due to the enhancement, providers may notice minor differences in the clinical claims editing
that include National Correct Coding Initiative (NCCI) and Outpatient Hospital edits. Providers should expect that most claims will continue to be
edited in the same manner; but when applicable, claims may now pay or deny differently.
'Clear Claim Connection' is the related web-based reference tool that enables providers to access the editing rules and clinical rationale for some
of the 'ClaimCheck' edits. This reference is in the process of being aligned with the updates to the editing product described above. Providers
may see temporary differences when they use this tool until the corresponding update is made. Please keep in mind that 'Clear Claim Connection'
is for reference only and the results are not a guarantee of how claims will finalize in the claims processing system.
For questions related to this information, please contact Molina Medicaid Solutions Provider Services at
(800)473-2783 or (225)924-5040.
ATTENTION FREE-STANDING REHABILITATION CENTER PROVIDERS
Effective with dates of service on or after February 1, 2013, Rehabilitation Clinics (Provider Type 65) which are
private/free-standing clinics will no longer receive reimbursement for rehabilitation services for Medicaid recipients age 21 and older.
This does not include rehabilitation services provided by hospital-based providers and home health agencies. This only
applies to Providers Type 65 who provided services to recipients over 21.
In cases where Medicaid is the secondary coverage to private insurance, Medicaid shall no longer be billed for the recipient
responsibility and therefore, the recipient may be billed for the co-payments. In instances where Medicare is the primary payer,
Medicaid shall only be billed when the recipient is certified as a Qualified Medicare Beneficiary (QMB). Providers may
bill all other Medicare recipients the co-insurance and deductible amounts.
There are no changes of any kind for Medicaid rehabilitation services for recipients under the age of 21.