RA Messages for February 24, 2009
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.
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
ATTENTION LTC PROVIDERS
When entering the Number of Days in the
Value Code Fields 39, 40 or 41 of hard copy/paper UB claim forms, you
MUST correctly follow the billing instructions which state: "Enter the
appropriate Value Code in the "Code" portion of the field and the Number
of Days in the "Dollar" portion of the "Amount" section of the field.
Enter "00" in the "Cents" portion of the "Amount" section of the field."
Failure to enter "00" in the "Cents" portion of the field OR entering
the number of days in the "Cents" portion of the field will cause the
claim to deny. Additionally, these same instructions must be followed
when submitting hard copy Medicare Crossover claims that do not cross
automatically from the Medicare carrier. Failure to enter co-insurance
days on Medicare crossovers when appropriate will result in claims
denials for Code 087. Please make any needed changes to your software
and/or procedures to ensure that this information is entered correctly
on all paper claims for Medicaid.
Contact Unisys Provider Relations at (800)473-2783 or (225)924-5040 if
you have questions concerning these instructions.
PROFESSIONAL SERVICES PROVIDERS
Effective with date of service July 1,
2008, Louisiana Medicaid will reimburse for digital mammography
services, currently HCPCS codes G0202 (Screening mammography, producing
direct digital image, bilateral, all views), G0204 (Diagnostic
mammography, producing direct digital image, bilateral, all views), and
G0206 (Diagnostic mammography, producing direct digital image,
unilateral, all views).
Providers should perform the most clinically appropriate method (film or
digital) specific to the recipient. One screening mammography is allowed
(either film OR digital) per female recipient aged 40-99, per calendar
ATTENTION PROFESSIONAL SERVICES
2009 HCPCS UPDATE
Claims denied due to use of new 2009 codes prior to them being added to
our system will be recycled and appear on the RA of 2/17/09.
ATTENTION ALL PROVIDERS
You were notified several weeks ago about the funding of additional NOW
waiver slots through the NOW Trust Fund. At that time, you were notified
that the addition of these slots was effective on or after November 3,
2008. The correct date for the addition of these slots is October 1,
2008. You were also informed that a system for processing the claims
for these recipients was under development and any associated claims
were pending, awaiting this development. The claims system is now complete, and any claims submitted for waiver recipients in NOW Trust Fund
slots will now process correctly through the claims processing system.
ATTENTION MEDICAID PROVIDERS
DELAYED IMPLEMENTATION OF REIMBURSEMENT RATE REDUCTIONS
In order to avoid a budget deficit in the medical assistance programs,
the Department of Health and Hospitals has determined that reimbursement
rate reductions are necessary. For details regarding what services are
affected by these reductions as well as the effective date of the reductions, please refer to the emergency rules published on January 30
or 31, 2009 in the legal notice section of the major daily newspaper in
your area or the emergency rule section on the Office of the State
Register's website (http://doa.louisiana.gov/osr/). No action is required by providers. Systematic adjustments to affected paid claims will
occur in the near future. Providers should monitor the Louisiana Medicaid website (www.lamedicaid.com)
for updates regarding the rate reductions and effective dates.
ATTENTION PROVIDERS OF ADULT
RECYCLE: DENIED CLAIMS
Effective with date of service 10/1/07, LA Medicaid made select vaccine
CPT procedure codes payable to professional service providers for adult
recipients ages 21 and older. See the RA messages dated 11/13/07 and 10/28/08 for details. Affected claims that denied for services provided
on or after 10/1/07 will be systematically recycled on the RA of
2/24/09. If providers determine the need to resubmit any claims, voids,
or adjustments after this recycle is complete in order to rectify any
outstanding issues, providers should review the claim void/adjustment
policy and procedures in the 2007 Louisiana Medicaid Professional
Services Provider Training, pages 121 and 128. Contact Unisys Provider
Relations at (800) 473-2783 with any questions.
ATTENTION PROVIDERS OF
RECYCLE: IMMUNIZATION ADMINISTRATION REIMBURSEMENT CHANGES
administration procedure codes impacted by the reimbursement rate changes effective for dates of service 8/6/08 and after are
being systematically adjusted and will appear on the RA of 2/24/09. See
the RA message dated 12/16/08 for details. Claims where the billed
charges were less than or equal to the previous fee on file will not be
included in this systematic adjustment. For this situation, if providers
determine adjustments are needed, providers should review the claim adjustment policy and procedures in the 2007 Louisiana Medicaid KIDMED
Provider Training, pages 38 and 64 or the 2007 Louisiana Medicaid Professional Services Provider Training, pages 121 and 128. Contact Unisys
Provider Relations at (800) 473-2783 with any questions.