RA Messages for March 2, 2010
PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
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
IMMUNIZATION PAY-FOR-PERFORMANCE ENROLLED PROVIDERS
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.
MULTI-SYSTEMIC THERAPY (MST) PROVIDERS
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.
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.
2010 HCPCS UPDATE
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.
PROFESSIONAL SERVICES PROVIDERS
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'.