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
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
New and Revised Place of Service Codes (POS) for Outpatient Hospital
Implementation Date 01-01-2016
The Centers for Medicare and Medicaid Services (CMS) made changes to the existing place of service code set by creating a new place of service (POS) code, code 19 (Off Campus-Outpatient Hospital), and revised the POS Code 22 (On Campus-Outpatient Hospital).
Louisiana Medicaid will accept POS 19 for any claims processed on or after January 1, 2016. That is, POS code 19 is valid for any claim, regardless of the date of service, when it is processed on or after January 1, 2016. The payment policies that currently apply to POS 22 will continue to apply to this POS, and will now also apply to POS 19.
CMS also issued minor corrections to POS codes 17 (Walk-in Retail Health Clinic) and 26 (Military Treatment Facility).
To access the CMS POS code set go to: https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html.
Should you have questions related to the place of service codes changes, please contact Molina Providers Relations at 1-800-473-2783. Questions regarding submission of claims to/payment by the correct entity should be directed to the MCO.
ATTENTION HOME HEALTH PROVIDERS:
TRANSITION TO 15-MINUTE UNITS FOR RN AND LPN SERVICES
In the past, home health providers have been instructed to bill skilled nursing services by a registered nurse (RN) or licensed practical nurse (LPN) with l unit for a visit. National guidelines require these services to be billed in 15-minute units.
Effective for dates of service on or after April 1, 2016, claims processing logic will be updated to reflect the intent of Medicaid policy and National guidelines related to Home Health Services for skilled nursing visits (HH 15 min for RN and LPN).
Beginning with date of service April 1, 2016, providers will be required to bill for skilled nursing visits in 15-minute units. Providers are encouraged to make changes to internal processes and systems to accommodate the change and avoid claims payment issues.
To substantiate the provider's claim for the number of 15-minute units billed for the visit, provider documentation of the visit must reflect the arrival time and departure time of the nurse. This documentation must be retained and made available for review upon request according to Medicaid standards for provider participation. If you have questions about the content of this message, you may contact Molina Provider Relations at 1-800-473-2783.
ATTENTION PHARMACY AND PRESCRIBING PROVIDERS:
REMINDER- Pregnant women are exempt from paying copays on pharmacy claims. When writing prescriptions for pregnant women, prescribers should indicate on the prescription that the recipient is pregnant. Pharmacists can override the copay requirement for pregnant women by placing a value of “08” in NCPDP field 461-EU (Prior Authorization Type Code). Please see "FFS Pharmacy Copays for Pregnant Women" on www.lamedicaid.com for further details.
Attention Fee for Service (FFS) Louisiana Medicaid Providers:
Effective March 29, 2016, Fee for Service pharmacy claims for elbasvir/grazoprevir (Zepatier®) will have edits at Point of Sale (POS) similar to the other Hepatitis C direct acting antiviral agents. Please refer to www.lamedicaid.com for specifics.
Attention Support Waivers Providers
Supports Waiver claims for service codes T2021, T2021 UQ and T2021 TT for dates of service March 1, 2016 were denied due to a system issue. All of these claims received a 210 error (Provider not certified to provide this service). The system issue has resolved and for these claims and the 241 (Pre-payment Review) error has been bypassed for the check write 3/29/16.
If you have questions regarding this matter contact Tracy Barker at 225-342-8156 or email at Tracy.Barker2@LA.GOV.