RA Messages for March 2, 2010


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 www.lamedicaid.com


The Department of Health and Hospitals has determined that to avoid a budget deficit, a change in the Immunization Pay-for-Performance Initiative (P4P) is necessary. Effective with P4P payments for February 2010 and thereafter, the initial benchmark measurement to receive a payment will be that 50% to 74% of the recipients linked to the participating CommunityCARE PCP must be up to date by age 24 months to be eligible to receive an incentive payment. No changes are being made to the second or third level benchmark or payments. Detailed information on the P4P incentive payment initiative can be found on the www.lamedicaid.com website following the link Pay-For-Performance. For details regarding the Emergency Rule associated with this change, please go to the Emergency Rule section of the Louisiana Register at the Office of the State Register's website http://doa.louisiana.gov/osr/. Contact Unisys PR at (800) 473-2783 or (225) 924-5040 if you have any questions.


The LA Medicaid claims processing system will accommodate claim lines billed with DIFFERENT Place of Service codes on the same day to accommodate situations where it is necessary for the recipient to receive services in two or more different locations on the same date of service. However, all services provided at the same service locations (Place of Service) on the same date of service should be rolled together and billed as one claim line with the total units of service for that location - even when you see the recipient at different times of the day in the same location. Claim lines billed with the SAME Place of Service code and the SAME Date of Service will deny with edit 689.

Additionally, MST claims must be billed using the most current and specific diagnosis code(s) for the diagnosis. General diagnosis codes are no longer acceptable on any LA Medicaid claims. Please ensure that you are using the most current, specific code on your claims submissions. You should obtain the specific code from the mental health professional that performed the evaluation for admission to MST services.


Effective with date of service February 22, 2010, LA Medicaid will implement the use of two new modifiers (U2 and U3) and a new prior authorization requirement for providing multiple visits for the same recipient on the same date of service. Multiple visits will be authorized only for recipients under 21 years of age. Please visit the homepage of our website, www.lamedicaid.com, for details.


 The Louisiana Medicaid files have been updated to reflect the new and deleted HCPCS codes for 2010. Refer to the Professional Services Fee Schedule on the LA Medicaid website, www.lamedicaid.com. Claims denied due to use of the new 2010 codes prior to their addition to our system will be systematically adjusted and no action is required from providers. Appropriate editing and coverage determinations for the new codes are still underway and systematic adjustments for some previously processed claims may be necessary in the future. Please note that LA Medicaid will continue to allow the use of consultation procedure codes at this time. Also, as a part of these editing and coverage determinations, the newly created procedure code A4264 (Permanent Implantable Contraceptive Device) has been placed in non-pay status effective January 1, 2010. Providers should continue to monitor RA messages for future updates for the 2010 HCPCS updates.

The 2010 'Current Procedural Terminology' manual includes information on the appropriate reporting of the new codes. It is the intent of Louisiana Medicaid that these instructions be followed. All payments are subject to post payment review and recovery of overpayments.

Global Surgery Period (GSP) Updates

It has come to Louisiana Medicaid's attention that a number of procedure codes were inadvertently omitted from our Global Surgery Policy (GSP) editing that should have been included. The system update is complete and is effective with DATE OF PROCESSING February 22, 2010, and will appear on the RA's from March 2, 2010, forward. Providers may see claim denials related to the GSP (Error Codes 690 or 691) on procedure codes that previously did not receive these denials. Providers can currently view the "GSP DAY" for individual procedure codes on the Professional Services Fee Schedule found on the Louisiana Medicaid website: www.lamedicaid.com, using the 'Fee Schedule' link.

Further updates on GSP editing are expected to occur related to the implementation of the McKesson 'ClaimCheck' claims editing product, currently scheduled for mid-May 2010. Updates related to 'ClaimCheck' implementation can be viewed via the specific 'ClaimCheck' link also on the Medicaid website. Providers are encouraged to visit this site frequently for the latest information on 'ClaimCheck'.