PHARMACY PROVIDERS, PLEASE NOTE!!!

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 REMINDER

On August 11, 2014, Molina systemically voided all identified paid claims for legacy and shared plan recipients associated with the retroactive enrollment or dis-enrollment of Bayou Health members and plan linkages from February 1, 2012 through June 30, 2014. These voids appeared on RAs with edit 999, Administrative Correction.

A Remittance Advice message ran from July 29, 2014 through August 12, 2014 and a web notice was posted on August 8, 2014 notifying providers that DHH would void all paid claims.

The 6 month deadline to resubmit these voided claims is February 11, 2015.

We are reminding providers that this deadline is approaching.

All claims and required documentation must be resubmitted to the correct entity by that date in order to be considered for payment.

Providers should refer to the web notice (08/06/14) or RA messages mentioned above for detailed directions on how to resubmit these claims.

If you have any additional questions or concerns, please contact Darlene White at (225)342-5924 or Darlene.White@la.gov

ATTENTION ALL PROVIDERS
CHANGES IN POST OFFICE BOXES FOR SUBMISSION OF PAPER CLAIMS
EFFECTIVE FEBRUARY 1, 2015

Effective February 1, 2015, Molina will be consolidating several Post Office boxes and providers should begin sending claims to the newly assigned box.

Below is a list of the Post Office boxes currently used (indicated as Old Box Number) and a list of the corresponding 'New' box assigned for that claim type (indicated as New Box Number).

Please share this information with your staff and make the necessary changes in your internal procedures to begin sending your paper claims to the new box immediately.

Old Box Number New Box Number

91019

(Pharmacy)

 91020

91021

(Hospital/Hemodialysis/Hospice/LTC)

 91020

91022

(Dental/Home Health/Rehab/Transportation)

 91020

91023

(All Medicare Crossovers)

 91020

14849

(KIDMED)

 Program ended 2012; claims may no longer be submitted.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040. Thank you for your assistance in this matter.

Attention ALL Louisiana Medicaid Providers:

Effective February 1, 2015, all claims must be filled within 180 days from the date of service with some exceptions. Exceptions include:

Exceptions:

  • Hospital lnpatient claims must be filed within 180 days from the date of discharge
  • Claims for members who have Medicare and Medicaid coverage must follow Medicare timely filing guidelines and submit to Medicaid within 180 days from Medicare's EOB.
  • Claims for Retroactive Medicaid members must be filed within 180 days from eligibility determination.
  • Adjustments and Voids must be filed within 180 days from Date of Payment.
  • Services billed to and reimbursed by Magellan

This will be effective February 1, 2015. Claims with a date of service and/or date of discharge through January 31, 2015 will follow the 365 day timely filing guidelines. Claims with date of service and/or date of discharge of February 1, 2015 or later will follow the new timely filing guidelines, see above.

Your continued cooperation and support of the Louisiana Medicaid Program efforts to coordinate care and improve health are greatly appreciated.

If you have questions about the contents of this memo, you may contact Molina Provider Relations at (800) 473-2783 or refer to www.lamedicaid.com.

OSS Checks

Molina has experienced problems with the issuance of the Optional State Supplement (OSS) checks. DHH/Molina apologizes for any inconvenience the non-issuance of these checks may have caused and the necessary programming is being completed to update these issuances. Please be advised that the January checks will be ready for issuance on or before January 28, 2015. Molina continues to work on programming that will correct the other existing errors with the OSS checks. Thanks for your time and patience.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention: All Providers

Effective 2/1/2015, all LaHIPP claims with dates of service 2/1/2015 forward will be paid using the cost comparison methodology used to pay TPL claims for non-LaHIPP recipients with primary insurance. All LaHIPP claims with dates of service prior to 2/1/2015 will continue to be processed paying the full patient responsibility (co-pay, co-insurance, and/or deductible). Also, effective 2/1/2015, e-MEVS, MEVS, and REVS will no longer identify Medicaid recipients with LaHIPP by the response "This Recipient is Enrolled in LAHIPP".

If you have questions, please call Jackie Porta @ 225-342-9463 or Danny Murnane @ 225-342-4902. Thank you for your cooperation in this matter.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid (Legacy/Fee for Service) Pharmacy Program:

Effective February 4, 2015, clinical pre-authorization will be required on pharmacy claims for Latuda® (Lurasidone), Fanapt® (lloperidone), and Saphris® (Asenapine) for recipients less than 18 years old. Please refer to www.lamedicaid.com for specfics.

National Correct Coding Initiative - 2015 Quarter One Editing Update

The Centers for Medicare and Medicaid Services (CMS) provides State Medicaid agencies with updates to the National Correct Coding Initiative (NCCI) procedure to procedure (PTP) edits on a quarterly basis. Effective with date of processing February 2, 2015 providers may notice some differences in NCCI editing specific to professional, ASC and outpatient hospital services. Providers should expect some claims may now pay or deny based on the changes CMS has provided to NCCI editing.

For questions related to this information as it pertains to legacy Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION OBSTETRICAL SERVICES PROVIDERS:

Reimbursement of delivery codes including antepartum care is intended for providers only when billing third party coverage. Providers are reminded that they may not bill for services that they did not provide. This includes postpartum care prior to providing that service.

Legacy Medicaid policy related to the billing of prenatal care has not changed. Please see the Professional Services provider manual on the Medicaid website, www.lamedicaid.com. Claims submitted for reimbursement of delivery codes including antepartum care for recipients not involving third party coverage are subject to Program Integrity review and recoupment.

For questions related obstetrical services through the Legacy Medicaid Professional Services program, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS: OUTPATIENT VISIT EXTENSIONS

The Louisiana Medicaid program has updated policy related to outpatient visit extensions. The criteria for approval has changed. Extension requests that have been reviewed and deemed medically necessary will be approved. Providers should refer to the revised policy located under "Exclusions and Limitations" in the Professional Services Provider Manual.

The Department is currently revising the Physician Outpatient Visit Extension Form (158-A). Providers should continue to use the current form located on the Medicaid website, www.lamedicaid.com until the revised form is available.

For questions related to the outpatient visit extensions updated policy for the Professional Services program, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION PROVIDERS SUBMITTING SHARED PLAN CLAIMS WITH A 52 MODIFIER
(REVISED)

While reviewing Shared Plan paid claims from UHC and CHS with dates of service back to 2/1/12 , we have found two issues related to claims submitted with a 52 modifier appended to procedure codes which were paid in error:

  • Some of these paid claims were actually aborted procedures rather than reduced services, and aborted procedures are not payable.

  • Claims were submitted electronically to the Plans without proper documentation to support the use of the 52 modifier.

Changes have since been made to Molina's system to prevent inappropriate payment of these claims.

On the RA of 01/27/15, claims for reduced services that were approved by UHC and CHS will be reprocessed to ensure that providers receive the correct payment.

On the RA of 2/10/15, Molina will void inappropriate payments made for aborted services and for reduced services that were submitted electronically to the Shared Plans.