RA Messages for March 09, 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 MEDICAID PROVIDERS
EFFECTIVE IMMEDIATELY: 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. These reductions were initially delayed, but systems logic is
now effective, and providers will begin seeing these reductions on the
3/9/09 RAs. Systematic adjustments to affected previously paid claims
will occur in the near future. No action is required by providers.
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/). Providers should visit the Louisiana
Medicaid website (www.lamedicaid.com) for information regarding the rate
reductions and effective dates.
ATTENTION MEDICAID PROVIDERS
ADDITIONAL REIMBURSEMENT RATE REDUCTIONS- ASC, CRNA, ESRD, LAB & X-RAY
Effective with date of
service February 26, 2009, rate reductions were implemented for the
following programs: Ambulatory Surgical Centers (non-hospital),
Professional Services Program Anesthesia Services- Certified Registered
Nurse Anesthetists, End Stage Renal Disease Facilities and Laboratory &
Radiology services. Emergency rules for reimbursement rate reductions
were published for these on or before February 25, 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/). Claims paid at inappropriate rates due
to delay in implementation will be systematically adjusted and no action
is required by providers. Providers should monitor future RAs for
updates regarding these rate reductions.
ATTENTION PROFESSIONAL SERVICES
"QW MODIFIER UPDATE"
Please note that the system
has been updated and the following CPT codes require a QW modifier:
Effective with date of service 10/4/2006: codes 82042, 82150, 82247,
82977, 84075, 84157, 84520 and 87808. Effective with date of service
10/22/2007: code 86703. Effective with date of service 10/30/2007: code
80051. Effective with date of service 1/1/2008: code 80047. Effective
with date of service 1/16/2008: codes 80048 and 80053.
Claims that previously denied due to error 386 (Not Payable with CLIA
Cert Type) for the aforementioned procedure codes were systematically
adjusted with the RA of 2/17/2009.
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.
ERROR IN PROCESSING IMMUNIZATION ADMINISTRATION REIMBURSEMENT
Providers were notified through an RA message on 2/24/09
that claims affected by a recent rate adjustment of certain immunization
administration codes were systematically recycled on the RA of 2/24/09.
A file error caused these claims instead to deny on the 2/24/09 RA with
edit 799. The correct file will be systematically recycled on the RA of
3/3/09. Please disregard the erroneous 799 denials from 2/24/09.
Providers do not need to take any action. We apologize for any
inconvenience this may have caused.
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.