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
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
New and Revised Place of Service Codes (POS) for Outpatient Hospital
Implementation Date 01-01-2016
The Centers for Medicare and Medicaid Services (CMS) made changes to the existing place of service code set by creating a new place of service (POS) code, code 19 (Off Campus-Outpatient Hospital), and revised the POS Code 22 (On Campus-Outpatient Hospital).
Louisiana Medicaid will accept POS 19 for any claims processed on or after January 1, 2016. That is, POS code 19 is valid for any claim, regardless of the date of service, when it is processed on or after January 1, 2016. The payment policies that currently apply to POS 22 will continue to apply to this POS, and will now also apply to POS 19.
CMS also issued minor corrections to POS codes 17 (Walk-in Retail Health Clinic) and 26 (Military Treatment Facility).
To access the CMS POS code set go to: https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html.
Should you have questions related to the place of service codes changes, please contact Molina Providers Relations at 1-800-473-2783. Questions regarding submission of claims to/payment by the correct entity should be directed to the MCO.
Attention Providers of Obstetrical and Gynecological Services:
Implanon (J7306) Discontinued
Louisiana Medicaid has been informed by the makers of Implanon (J7306) that it has been discontinued and will no longer be available for use. Effective with dates of service January 1, 2016 and forward, Implanon (J7306) will no longer be covered by Legacy Medicaid. Nexplanon (J7307) however, continues to be available and covered by Legacy Medicaid.
Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.
Attention Fee for Service (FFS) Louisiana Medicaid Providers:
Some Medicaid recipients have their Behavioral Health coverage provided through a Bayou
Health Managed Care Organization (MCO) plan, but their Pharmacy Benefits are provided
through FFS Medicaid. These individuals will have a Managed Care Organization membership card without pharmacy benefits information such as PCN, BIN, and/or Group Number. Please bill FFS for these pharmacy claims.
Attention EPSDT-Personal Care Services (EPSDT-PCS) Providers
Effective for all dates of service 3/1/16 and forward, there will be no exceptions made for reimbursement of services performed without a current prior authorization (PA). Medicaid policy states that all EPSDT-PCS services must be prior authorized before services begin. Services provided without a current PA are not eligible for reimbursement.
Requests that do not include complete and accurate documentation prior to the service start date will be denied. In keeping with Medicaid policy, complete and accurate documentation includes but is not limited to, a prescription signed by a physician prior to the beginning date of service.
Providers should refer to the Personal Care Services provider manual located on the Louisiana Medicaid website, www.lamedicaid.com for additional information on how to submit PA requests.
Attention Fee for Service (FFS) Louisiana Medicaid Providers:
Some Medicaid recipients have their Behavioral Health coverage provided through a Bayou Health Managed Care Organization (MCO) plan, but their Pharmacy Benefits are provided through FFS Medicaid. These individuals will have a Managed Care Organization membership card without pharmacy benefits information such as PCN, BIN, and/or Group Number. Please bill FFS for these pharmacy claims.
2016 HCPCS Update
(Professional, Laboratory and Radiology, Outpatient Hospital)
The Louisiana Medicaid fee for service files have been updated to reflect the new and deleted Healthcare Common Procedure Coding System (HCPCS) codes effective for dates of service January 1, 2016 and forward. Providers will begin to see these changes on the remittance advice (RA) of February 16, 2016. Claims that have been denied due to use of the new 2016 codes prior to their addition to the claims processing system will be systematically recycled with no action required by providers.
The Professional Services, Laboratory and Radiology, and Outpatient Hospital Fee Schedules are being updated to reflect the new 2016 procedure codes. These updates are expected to be available on the Louisiana Medicaid website, www.lamedicaid.com the week of February 22, 2016.
Providers should monitor their RA messages for additional information on fee for service updates. Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for fee for service claims. Questions related to the Bayou Health managed care organizations' updates should be directed to the specific health plan.
2016 Assistant Surgeon and Assistant at Surgery Covered Procedures
DHH has published the 2016 list of allowed procedures for assistant surgeons and assistant at surgery providers for legacy Medicaid. The list titled, "2016 Assistant Surgeon and Assistant at Surgery Procedure Codes" has been posted to the LA Medicaid website (www.lamedicaid.com) under the ClaimCheck icon. The revisions are based on updates made by the McKesson Corporation to their ‘ClaimCheck’ product. McKesson uses the American College of Surgeons (ACS) as its primary source for determining assistant surgery designations.
This list does not ensure payment but provides a comprehensive list of codes that may be allowed when billed by an assistant surgeon or by an assistant at surgery.
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. For questions regarding Bayou Health updates, please contact the appropriate health plan directly.