RA Messages for
March 8, 2011
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
ATTENTION PHARMACISTS AND PRESCRIBING
Focalin XR will be moved to the PDL. Effective March
1, 2011, Focalin XR will no longer require Prior Authorization.
ATTENTION ALL GNOCHC AND TAKE CHARGE FAMILY PLANNING PROVIDERS
We have identified a claims processing issue that occurred with the
implementation of the GNOCHC Program in the Greater New Orleans Area. When
recipients are eligible for both the GNOCHC Program and the TAKE CHARGE Family
Planning Waiver Program, claims submitted for services by the TAKE CHARGE
providers have denied indicating that the recipient is in the GNOCHC Program.
For these recipients, services provided by either program are allowed. The
claims processing logic for TAKE CHARGE claims has been corrected to allow these
claims to process and pay appropriately. Denied claims are being reprocessed on
the RA of 2/22/2011. We apologize for any inconvenience this has caused to
providers rendering services to these recipients.
ATTENTION ALL PROVIDERS 2011
The Louisiana Medicaid files have been updated to reflect the new
and deleted HCPCS codes for 2011. Refer to the Professional Services Fee
Schedule on the LA Medicaid website, www.lamedicaid.com. Claims denied due to
use of the new 2011 codes prior to their addition to our system will be
systematically adjusted on March 8, 2011, 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. Providers should continue to monitor RA messages
for future updates for the 2011 HCPCS updates.
Additionally, the "Assistant Surgeon/Assistant at Surgery Covered Procedures
List" under the 'ClaimCheck' icon on the website homepage will be updated to
reflect the applicable 2011 procedure codes. As a reminder, 'ClaimCheck' uses
the American College of Surgeons (ACS) as its primary source for determining
assistant surgeon designations.
TThe 2011 '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.
ATTENTION ASC (NON-HOSPITAL) AND FREE STANDING ESRD FACILITIES
SYSTEMATIC CLAIMS ADJUSTMENT FOR RATE REDUCTIONS EFFECTIVE JAN 1, 2011
effective date for the 2% rate reduction for ASC (Non-Hospital) and Free
Standing ESRD Facilities services has been changed from December 1, 2010 to
January 1, 2011. Refer to the LA Medicaid website (www.lamedicaid.com) and the
Office of the State Register's website at http://doa.louisiana.gov/osr/
published rules detailing these reductions. The system has been updated to
reflect this change. Claims for dates of services December 1, 2010-December 31,
2010 that were adjudicated prior to the new January 1, 2011 effective date will
be systematically adjusted on the RA of February 22, 2011. Providers should
reference the "Fee Schedules" link on the homepage of the LA Medicaid website
(www.lamedicaid.com) for the most current fees. Contact the Provider Relations
unit at (800) 473-2783 or (225) 924-5040 with questions related to the
implementation of the rate reductions or adjustment of claims.
ATTENTION PROFESSIONAL SERVICE PROVIDERS
of the Correct Coding Initiative, we would like to remind providers to refer to
the Current Procedural Terminology (CPT) manual for the most appropriate
procedure code to bill for the insertion of Mirena. We realize that this
contradicts previous published policy, and providers may void and re-bill claims
within the two year timely filing period. Providers should contact the Provider
Relations unit at (800) 473-2783 or (225) 924-5040 with billing or policy
ATTENTION PROFESSIONAL SERVICE PROVIDERS AND OUTPATIENT HOSPITALS:
DIABETES SELF MANAGEMENT TRAINING (DSMT)
Effective February 20, 2011, Louisiana
Medicaid will provide coverage for Diabetes Self-Management Training services
rendered to Medicaid recipients diagnosed with diabetes. For coverage details
for DSMT services, refer to www.lamedicaid.com. Providers should also monitor
the website for updated information and upcoming policy. Providers should
contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with
billing or policy questions.
ATTENTION ALL PROVIDERS (EXCEPT ATYPICAL)
In order to comply with
federal requirements to include the National Provider Identifier (NPI)
on all claims, changes to current claims processing will be made over
the next two months. Providers using the Molina Form 213 for Physician
Crossover Adjustments, Professional Crossover Adjustments, Durable
Medical Equipment Adjustments, Durable Medical Equipment TPL
Adjustments, and Physician Adjustments will need to begin using the
CMS-1500 claim form; providers using the Rehabilitation forms for claims
and adjustments (102, 202) will instead be required to use the CMS-1500
form. Over the coming months, changes to Dental (209, 210), Pharmacy
(211), and KIDMED (KM-3) claim forms will also be introduced to
accommodate these federal requirements. Providers who have software
vendors must alert their vendors of the changes. Please monitor the
Louisiana Medicaid website, www.lamedicaid.com, for an implementation
schedule and more details.
ATTENTION DURABLE MEDICAL EQUIPMENT (DME)
Please note the following DME
HCPCS codes which are being discontinued (12/31/2010) and the
appropriate replacement codes which are to be submitted for prior
authorization (PA) request dated 01/01/2011 forward. The PA requirements
and medical necessity criteria that were applicable for the discontinued
codes apply for the replacement codes.
The payment amounts for the replacement codes are noted on the updated
fee schedule which can be found on www.lamedicaid.com.