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 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.
The 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 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.
ATTENTION EARLYSTEPS PROVIDERS - SYSTEMATIC
FOR RATE REDUCTIONS EFFECTIVE JAN.1, 2011
The effective date for the 2% rate reduction for
EarlySteps services provided in the natural environment 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
http://doa.louisiana.gov/osr for published rules detailing these
reductions. The system has been updated to reflect this change. Claims
for dates of services Dec 1, 2010-Dec 31, 2010 that were adjudicated
prior to the new Jan 1, 2011 effective date will be systematically
adjusted on the RA of March 15, 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
NOTICE TO PROVIDERS OF HOSPICE SERVICES
Upon a revocation or discharge a patient will lose
the remaining days in that election period. The individual may at any
future time elect to receive hospice coverage for any other hospice
periods for which he/she is eligible. Please visit www.lamedicaid.com
for further details.
URGENT NOTICE: ALL MEDICAID PROVIDERS
CMS MANDATE - NATIONAL CORRECT CODING INITIATIVE (NCCI) EDITING
FOR MEDICAID SERVICES
Under new federal regulations signed into law in
2010, State Medicaid Agencies must incorporate and apply editing
methodologies of the National Correct Coding Initiative (NCCI). CMS has
granted some flexibility to the States to fully implement the editing
into their systems until April 1, 2011.
For more detailed information related to this CMS mandate, including
provider types affected and further explanation of the edits, providers
are directed to the Louisiana Medicaid website at www.lamedicaid.com and
the CMS website at www.cms.gov under the Medicaid links related to NCCI.