RA Messages for March 17, 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 DENTAL PROVIDERS
rates for certain procedures and coverage for additional procedures for
the EPSDT Dental Program have been approved by CMS, effective for dates
of service on and after December 24, 2008. Implementation of these
changes will be delayed because required programming changes have yet to
be complete; therefore, Medicaid will recycle affected claims. Complete
details will be placed on the www.lamedicaid.com website under the
"Billing Information" and "Fee Schedule" links. If you have questions,
you may contact the LSU Dental Medicaid Unit at 504-941-8206 or
ATTENTION COMMUNITY MENTAL
HEALTH CENTER (CMHC) PROVIDERS
At the request of the CMHC
provider community, we are again extending the cut-off date for
retroactive claims and will allow all CMHC providers to resubmit older,
retroactive claims in an effort to "clean up" any unresolved claims left
outstanding. Additionally, providers will be allowed to submit claims
with dates of service from 1/1/2003 but MAY NOT SUBMIT any claims prior
to their Medicare enrollment date. This is a change from the original
1/1/2005 effective date. Providers who meet the Medicare enrollment
criteria and are interested in submitting claims with dates of service
1/1/2003-12/31/2004 must notify Unisys Provider Enrollment in writing
with their request to change their Medicaid enrollment effective date
and state the date requested. This request must be signed by someone
affiliated with the CMHC who is authorized to make changes and sign on
behalf of the provider and must be faxed to the Provider Enrollment unit
This will be the final extension for these older claims, and the
following procedures must be followed: (1) These claims may have dates
of service from 1/1/2003 through 6/30/2008. (2) Any and all claims with
these dates of service MUST be submitted electronically, regardless of
whether the denial was caused by provider error or Unisys error. NO
PAPER CLAIMS WILL BE ACCEPTED. This includes claims with TPL in addition
to Medicare. (3) Claims must be submitted/resubmitted by 4/30/2009, and
providers will be given a 2-month period from 5/1/2009-6/30/2009 to
reconcile accounts and resubmit any denied claims for consideration. The
final grace period ends on 6/30/2009.
Effective 7/1/2009 all CMHC crossover claims must be filed in accordance
with timely filing guidelines. Please contact Unisys Provider Relations
should you have questions.
Additionally, procedure codes G0410 and G0411 have been added to our
claims processing system for submission on claims with dates of service
1/1/2009 forward. Claims with dates of service 1/1/2009 forward that
have denied will be systematically recycled.
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.
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.