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.
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.
ATTENTION PRIMARY CARE PROVIDERS:
You are invited to complete a survey regarding the transition of Behavioral Health services from the Louisiana Behavioral Health Partnerships to the Bayou Health, Louisiana’s managed-care program for Medicaid. This transition means that Primary Care Physicians will now be able to bill Behavioral Health services to Medicaid patients.
Your confidential answers to this short survey will provide DHH Medicaid with the information to properly assist Primary Care Physicians in navigating through the Behavioral Health transition.
This important study is being conducted by Q2 Insights, a national research firm, on behalf of Louisiana Department of Health and Hospitals.
To complete the survey please click here. We appreciate you taking the time to participate.
ATTENTION HOME HEALTH PROVIDERS:
TRANSITION TO 15-MINUTE UNITS FOR RN AND LPN SERVICES
In the past, home health providers have been instructed to bill skilled nursing services by a registered nurse (RN) or licensed practical nurse (LPN) with l unit for a visit. National guidelines require these services to be billed in 15-minute units.
Effective for dates of service on or after April 1, 2016, claims processing logic will be updated to reflect the intent of Medicaid policy and National guidelines related to Home Health Services for skilled nursing visits (HH 15 min for RN and LPN).
Beginning with date of service April 1, 2016, providers will be required to bill for skilled nursing visits in 15-minute units. Providers are encouraged to make changes to internal processes and systems to accommodate the change and avoid claims payment issues.
To substantiate the provider's claim for the number of 15-minute units billed for the visit, provider documentation of the visit must reflect the arrival time and departure time of the nurse. This documentation must be retained and made available for review upon request according to Medicaid standards for provider participation. If you have questions about the content of this message, you may contact Molina Provider Relations at 1-800-473-2783.