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 http://www.lamedicaid.com/.
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
Prescribing Providers and Pharmacists
As affirmed in the April 2012 issue of the Louisiana Board of Pharmacy quarterly newsletter, be advised that pharmacy-generated refill authorization documents that are
received via fax from a prescriber represent a new prescription. As such, these prescription documents must be signed by the prescriber. They cannot be signed by the prescriber's agent.
National Correct Coding Initiative Edits 2013
The Centers for Medicare and Medicaid Services (CMS) has recently released the 2013 quarter one procedure to procedure edits as a part of the
mandated National Correct Coding Initiative (NCCI) editing. Included are edits that pair immunization administration codes with preventive
medicine codes billed on the same date of service by the same provider. This can result in the preventive medicine code being denied.
NCCI long-standing policy and methodology allows payment of both codes in this scenario IF significant, separately identifiable E & M service is
provided on the same day and the -25 modifier is appended to the E & M code.
As a result of comments received from the American Academy of Pediatrics and some state Medicaid agencies, CMS has decided to permit states to
deactivate these edits should they choose to do so. Per CMS on February 7, 2013, "It is understood that immunizations are commonly administered
in conjunction with a comprehensive preventive medicine evaluation and that, when this occurs, both services are payable." It would be expected
that all services provided are medically necessary and appropriately documented in the patient record.
Louisiana Medicaid (for fee for service and shared plan claims that process through the Molina claims processing system) will soon be
implementing the 2013 quarter one NCCI edits; however, the code pairs specific to preventive services and immunization administration
will be deactivated as CMS permits. Doing so aligns with our intent and expectations that appropriate immunizations are to be given at
the time of the preventive visit to avoid missed opportunities in both preventive care and immunizations.
Each Bayou Health prepaid plan is required to implement NCCI editing, but may have slightly different implementation schedules and billing
policy related to the mandate. It is understood that the prepaid plans will allow appropriate use of modifier-25 if they have activated
the code pairs in question. Please contact the plans directly for information specific to their implementation, policies, and any billing instructions.
For questions related to this information as it pertains to legacy Medicaid or Bayou Health shared plans, please contact Molina Medicaid
Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
TO ALL DME PROVIDERS
Providers will no longer use the miscellaneous HCPC E1399 for cough stimulating device when requesting prior authorization for this equipment.
Providers may submit any outstanding claims with existing prior authorizations using the E1399 for payment; however effective immediately,
request for these services must be submitted using the appropriate code.
The appropriate code E0482 has been added to the DME Fee schedule for payment. Also, this procedure code is only payable for members under
the age of 21. Reimbursement for this equipment will not be manually priced using E1399.
ATTENTION Providers and Hospitals Eligible for the EHR Incentive Payment Program
On May 1, 2013, Louisiana Medicaid will launch the NEW AND IMPROVED LAConnect, the online portal for eligible providers to apply for Medicaid EHR incentive payments. On May 1st, providers will be able to access the new system and complete the attestation process for Year 1 and Year 2 incentive payments.
After March 31, 2013, the current method of attestation will no longer be used by Louisiana Medicaid for participation in the EHR Incentive Payment Program. All attestations received after March 31st will be returned to the provider, and the provider will be instructed to apply on May 1st, using the NEW AND IMPROVED LAConnect. We apologize for any inconvenience. However, this transition period is needed to ensure a smooth and problem-free launch of the NEW AND IMPROVED LAConnect.