RA Messages for March 16, 2010
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
PHARMACISTS AND PRESCRIBING PROVIDER
Corrections to the
recently mailed Preferred Drug List (PDL) are:
Page 7, Insulins &
Related Agents, Levemir should be on "Drugs on PDL". Page 8, Proton Pump
Inhibitors, Kapidex name has changed to Dexilant. The Preferred Drug
List (PDL) will be updated on
2010 HCPCS UPDATE
Medicaid files have been updated to reflect the new and deleted HCPCS
codes for 2010. Refer to the Professional Services Fee Schedule on the
LA Medicaid website, www.lamedicaid.com. Claims denied due to use of the
new 2010 codes prior to their addition to our system will be
systematically adjusted 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. Please note that LA Medicaid will
continue to allow the use of consultation procedure codes at this time.
Also, as a part of these editing and coverage determinations, the newly
created procedure code A4264 (Permanent Implantable Contraceptive
Device) has been placed in non-pay status effective January 1, 2010.
Providers should continue to monitor RA messages for future updates for
the 2010 HCPCS updates.
The 2010 '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.
PROFESSIONAL SERVICES PROVIDERS
Global Surgery Period (GSP) Updates
It has come to
Louisiana Medicaid's attention that a number of procedure codes were
inadvertently omitted from our Global Surgery Policy (GSP) editing that
should have been included. The system update is complete and is
effective with DATE OF PROCESSING February 22, 2010, and will appear on
the RA's from March 2, 2010, forward. Providers may see claim denials
related to the GSP (Error Codes 690 or 691) on procedure codes that
previously did not receive these denials. Providers can currently view
the "GSP DAY" for individual procedure codes on the Professional
Services Fee Schedule found on the Louisiana Medicaid website:
www.lamedicaid.com, using the 'Fee Schedule' link.
Further updates on GSP
editing are expected to occur related to the implementation of the
McKesson 'ClaimCheck' claims editing product, currently scheduled for
mid-May 2010. Updates related to 'ClaimCheck' implementation can be
viewed via the specific 'ClaimCheck' link also on the Medicaid website.
Providers are encouraged to visit this site frequently for the latest
information on 'ClaimCheck'.
DISABLED ADULT (EDA) WAIVER
ENVIRONMENTAL ACCESSIBILITY ADAPTATIONS (EAA)
Attention providers of
Office of Aging and Adult Services Elderly and Disabled Adult (EDA)
Waiver Environmental Accessibility Adaptations (EAA) (formerly
Environmental Modifications) - Provider Type 15: Policy specific to the
EDA Waiver service of EAA is posted to the Policy/Procedures section of
the Publications page on the Office of Aging and Adult Services'
NOTICE REGARDING MEDSOLUTIONS' AUTHORIZATION NUMBERS
There has been an
error on some MedSolutions authorizations where the case number was
incorrectly shown as the Authorization Number on approval forms. This
error occurred on authorizations issued between February 15, 2010,
through February 24, 2010. MedSolutions will be sending corrected
authorizations to the approved facility. You may also look up a patient
authorization number at
www.medsolutionsonline.com. Log in with your user ID and password
and search the recipient/member ID. Please accept MedSolutions' apology
for this error and inconvenience.
LOUISIANA MEDICAID PROVIDERS
referral/authorizations are no longer required for administration of the
H1N1 Influenza Vaccine. Effective with date of service, October 1, 2009,
claims with CPT codes 90470 "H1N1 immunization administration
(intramuscular, intranasal), including counseling when performed" and
90663 "Influenza virus vaccine, pandemic formulation, H1N1" will bypass
error edit 106 (Billing provider not PCP). Claims for H1N1 vaccine
administration that previously denied for error edit 106 will be
FAMILY PLANNING WAIVER COVERAGE
REMOVAL OF PROCEDURE CODES
The TAKE CHARGE Family
Planning Waiver Program will be removing 3 procedure codes from the list
of approved codes for the program.
The codes are:
76830 - ECHOGRAPHY, TRANSVAGINAL
76856 - ECHOGRAPHY, PELVIC, REAL TIME
85025 - BLOOD COUNT; HEMO; PLAT COUNT
These codes will be made non-payable for all TAKE CHARGE recipients
effective 3/25/2010. If a TAKE CHARGE recipient is in need of the above
services, they will be responsible to pay for them out-of-pocket or the
provider can refer to the nearest charity facility in the recipients'
living area. It is the responsibility of the provider to inform the
recipient of financial responsibility of any uncovered services before
the service is rendered.