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.
ATTENTION ALL PROVIDERS BILLING TO LOUISIANA MEDICAID
The RA message relative to a change to timely
filing posted between January 20, 2015 and February 10, 2015 has been rescinded.
The timely filing guidelines set forth for providers billing to Medicaid
(Molina) will remain at one (1) year. This notice does not impact timely filing
requirements of the Bayou Health Plans.
If you have questions about the contents of this
RA, you may contact Molina Provider Relations at (800) 473-2783 or refer to
As always, we appreciate your prompt action to
communicate important information to our Medicaid provider community through
ATTENTION EPSDT-PCS PROVIDERS and HOSPICE PROVIDERS
Molina has identified claims for EPSDT-PCS services and Hospice services that were paid to providers in error for dates of service in February 2015. The incorrect payments occurred on Remittance Advice dates 2/10/2015, 2/17/2015, and 2/24/2015. Payments for these services should have been and are required to
be made by the Managed Care Organization (MCO) for this service population. Therefore, providers will receive voids for these payments on the check write of 3-31-2015. Providers are expected to verify the correct entity thru MEVS or REVS, and submit their claim(s) for payment to the appropriate MCO. Please contact Molina Provider Relations Unit at 1-800-473-2783 with your questions or concerns regarding these voids. Questions regarding linkage and submission of claims should be directed to the MCO.
ATTENTION OBSTETRICAL PROVIDERS
It was recently noted that the procedure code used by obstetrical providers when billing for the postpartal visit was inadvertently included in legacy Medicaid claims processing logic related to the denial of claims for non-medically necessary deliveries prior to 39 weeks gestation. The inclusion resulted in unintended denials. The postpartal visit procedure code has been removed from this logic. Claims that denied for error 496 for dates of service beginning 9/1/14 will be systematically recycled and appear on the remittance of 3/24/15 without any action required on behalf of the provider.
Please contact Molina Provider Relations (800)473-2783 or (225) 924-5040 for questions.
Update to 'ClaimCheck' Product Editing
McKesson's �ClaimCheck' product is routinely updated by the McKesson Corporation based on changes made to the resources used, such as Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding guidelines, the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule database, and/or provider specialty society updates. The �ClaimCheck' product's procedure code edits are guided by these widely accepted industry standards.
These edit changes will affect claims processed beginning with the remittance advice of March 24, 2015 forward. Providers may notice some differences in claims editing that includes Pre/Post-op Days, Incidental, Mutually Exclusive, Rebundling and Multiple Surgery Reductions. Providers should expect that some claims will continue to deny for the same error, but when applicable, claims may now pay or deny for a different reason. Providers will continue to be notified when these routine updates are made in the future.
For questions related to this information as it pertains to Legacy Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
2015 Assistant Surgeon and Assistant at Surgery Procedure Codes
DHH has published the 2015 list of allowed procedures for assistant surgeons and assistant at surgery for
legacy Medicaid. The list titled, "2015 Assistant Surgeon and Assistant at Surgery Procedure Codes" has
been posted to the LA Medicaid website
under the ClaimCheck icon. The revisions
are based on updates made by the McKesson Corporation to their 'ClaimCheck' product. McKesson uses the
American College of Surgeons (ACS) as its primary source for detennining assistant surgery designations.
This list does not ensure payment but provides a comprehensive list of codes that may be allowed when billed
by an assistant surgeon or by an assistant at surgery.
For questions related to this information as it pertains to Legacy Medicaid claims processing, please contact Molina
Medicaid Solutions Provider Services at (800)473-2783 or (225) 924-5040.
ATTENTION ALL PROVIDERS
2015 HCPCS UPDATE
The Louisiana Medicaid files have been updated to reflect the new and deleted codes for 2015. Providers will begin to see these changes on the RA of March 24, 2015. Claims that have been denied due to use of the new 2015 codes prior to their addition to our system will be systematically recycled with no action required by providers. Providers will be notified when this recycle will occur.
The Professional Services Fee Schedule and Outpatient Hospital Fee Schedules on the Louisiana Medicaid Website, www.lamedicaid.com will be updated in the near future to reflect the new 2015 HCPCS codes.
Providers should monitor their RA messages for additional information.