PHARMACY PROVIDERS, PLEASE NOTE!!!

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 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 2012 HCPCS UPDATE

The Louisiana Medicaid files have been updated to reflect the new and deleted HCPCS codes for 2012. Providers will begin seeing these changes on the RA of March 6, 2012. Professional Services Fee Schedules on www.lamedicaid.com will be updated in the very near future to reflect this update. Claims denied due to use of the new 2012 codes prior to their addition to our system will be systematically adjusted in the near future.

Providers will see denials of codes with 2012 date of service that were deleted effective December 31, 2011. Those claims should be resubmitted with the correct 2012 code.

Additionally, the "Assistant Surgeon/Assistant at Surgery Covered Procedures List," under the 'ClaimCheck' icon on the website, will be updated to reflect the addition of applicable 2012 procedure codes. 'ClaimCheck' uses the American College of Surgeons (ACS) as its primary source for determining assistant surgeon designations.

BILLING FOR RECIPIENTS ENROLLED IN A BAYOU HEALTH SHARED PLAN

The following services are not provided by the Shared Plans and will continue to be prior authorized and/or paid through Molina:

Dental, Pharmacy, Waiver services, Durable Medical Equipment, Long-Term Personal Care Services, EPSDT Personal Care Services, Hospice, Emergency and Non-Emergency Transportation Services, Nursing Facility, Intermediate Care Facilities for the Developmentally Disabled, Specialized Behavioral or Mental Health professional services, Case Management, Adult Day Health Care, EPSDT Health Services and Early Steps case management and medical services.

All other services must be billed to the BAYOU HEALTH Shared Plan the recipient is enrolled with.

BILLING FOR RECIPIENTS ENROLLED IN A BAYOU HEALTH PREPAID PLAN

The following are services not provided by the Prepaid Plans and will continue to be prior authorized and/or paid through Molina:

Dental, Pharmacy, Waiver services, Long-Term Personal Care Services, EPSDT Personal Care Services, Hospice, Nursing Facility, Intermediate Care Facilities for the Developmentally Disabled, Specialized Behavioral or Mental Health professional services, Case Management, Adult Day Health Care, EPSDT Health Services and Early Steps case management and medical services.

All other services must be billed to the BAYOU HEALTH Prepaid Plan the recipient is enrolled with.

THE FOLLOWING 5 MESSAGES ARE DIRECTED TOWARDS
BAYOU HEALTH PROVIDERS IN GSA-B (REGIONS 2, 3, AND 4)

1. ATTENTION LOUISIANA MEDICAID PROVIDERS

Effective for dates of service on or after 4/1/2012, claims for Medicaid State Plan Services provided to BAYOU HEALTH Plan members must be submitted to the Health Plan the member is linked to. If they are billed directly to Molina, the claims will deny, advising you to submit the claim to the Health Plan. Claims for carved out services not covered under BAYOU HEALTH Plans will continue to be billed to Molina. For further information, visit the website at www.makingmedicaidbetter.com. Click on the Providers link, and review the list of carved out services located on the 'Medicaid Provider Billing Changes for Dates of Service Beginning April 1, 2012' document.

2. ATTENTION PRIMARY CARE PROVIDERS (PCPs)

Have you enrolled with a BAYOU HEALTH Plan yet? If not, starting 4/1/12, you will no longer receive reimbursement for providing services to Louisiana Medicaid recipients enrolled in a BAYOU HEALTH Plan unless you have contracted with or made other arrangements with a BAYOU HEALTH Plan. For further information, visit the website at www.makingmedicaidbetter.com or participate in daily phone calls being held Monday through Friday with DHH by calling 1-888-278-0296, passcode 7299088.

3. ATTENTION LOUISIANA MEDICAID PROVIDERS

The CommunityCARE and KIDMED programs are ending statewide with the implementation of BAYOU HEALTH. As BAYOU HEALTH phases into a Geographic Service Area (GSA), CommunityCARE and KIDMED linkages for enrollees residing in the GSA will terminate.

There will be no new CommunityCARE or KIDMED provider enrollment applications processed. Provision of EPSDT screening services for KIDMED enrollees transitioning into BAYOU HEALTH will be the responsibility of the individual Health Plans.

Existing PCPs are notified of the procedure for ensuring uninterrupted medical care for transitioning CommunityCARE/KIDMED enrollees as BAYOU HEALTH implementation begins in the GSA. Notices for GSA B may be viewed at: www.la-communitycare.com, www.makingmedicaidbetter.com, or www.lamedicaid.com.

4. ATTENTION COMMUNITYCARE PROVIDERS

Current CommunityCARE Primary Care Providers (PCPs) that intend to continue rendering care to Louisiana Medicaid recipients as PCPs in the BAYOU HEALTH program must ensure that each Health Plan is provided with the 7-digit Medicaid legacy provider ID and corresponding NPI enrolled in CommunityCARE. PCPs with CommunityCARE linkages at more than one location must also include the appropriate 3-digit site number for each enrolled location. This information is available on the CommunityCARE CP-0-92 reports submitted for payment of the monthly management fees.

NOTE: Physician group practices, FQHCs, and RHCs must also provide the Medicaid IDs and NPIs for the individual practitioners at each CommunityCARE-enrolled location.

For assistance verifying the enrolled Medicaid legacy provider ID, PCPs may also contact the CommunityCARE contractor at 1-800-259-4444, option #3.

5. VERIFYING HEALTH PLAN & ELIGIBILITY INFORMATION FOR BAYOU HEALTH MEMBERS

Effective 4-1-2012, REVS, MEVS, and E-MEVS applications will show the name of the BAYOU HEALTH PLAN and their phone number for Medicaid recipients enrolled in BAYOU HEALTH. Enrollment in a BAYOU HEALTH Plan is for the entire calendar month. This information will be located where current CommunityCare PCP information is, and will no longer contain the PCP name. You may obtain PCP information from the BAYOU HEALTH Plan.

TO BAYOU HEALTH PROVIDERS ONLY IN GSA-A (Regions 1 and 9)
AND GSA-B (Regions 2, 3, 4)
UPDATE TO VERIFYING FUTURE MONTH HEALTH PLAN & ELIGIBILITY
INFORMATION FOR BAYOU HEALTH MEMBERS ONLY

DHH has completed revisions that will allow future month Health Plan and eligibility information to be shown in MEVS and e-MEVS. Revisions allow providers to obtain future enrollment information for dates of service up to 3 months. However, Plan Enrollment into a BAYOU HEALTH Plan may be prospective, and a recipient's eligibility for coverage under a Plan may be subject to change. Therefore, to ensure that you are using accurate and up-to-date eligibility information, it is your responsibility to re-check eligibility status with e-MEVS and your MEVS vendor prior to and on the date of service. If you fail to do so, and if you consequently provide services to a recipient who is ineligible on the date of service, you will not be paid for those services.

IMPORTANT INFORMATION FOR PROVIDERS ENROLLED IN BAYOU HEALTH
SHARED SAVINGS PLANS

With BAYOU HEALTH implementation, we have learned that some providers submitting claims through the Shared Health Plans are not including all Medicaid required information/data. Some providers are submitting claims as they do to private insurance companies. Claims billed to Shared Health Plans are ultimately processed and paid by Medicaid through Molina and must be submitted with required Medicaid data. Ensure that Shared Plan claims contain the necessary and required information entered correctly to prevent unnecessary denials. Visit www.lamedicaid.com for a detailed notice with some examples.

IMPORTANT INFORMATION CONCERNING CLAIMS UNDER PRE-PAYMENT REVIEW

With the implementation of pre-payment review for Medicaid claims, most claims processed to a 'pay' status undergo a delay for pre-payment review prior to payment being made. These 'pended' claims will appear on the RA as "Claims in Process" with edit 241 appended to the claim. This 'indicator' tells providers the claim is in pre-pay review. Providers are reminded that claims presented on the RA can appear under one of several headings: (1) Approved Original Claims (paid claims); (2) Denied Claims; (3) Claims in Process; (4) Adjustment Claims (claims being adjusted); (5) Previously Paid Claims (the corresponding data previously paid when claims are adjusted); and (6) Voided Claims (claims payments being voided).

These claims pending for edit 241 should not be worked or resubmitted. They will appear initially on an RA as "Claims in Process" and they will not appear again until they are released and paid. Once that review occurs and the claims are released, they will move to a paid status on the RA and appear as "Approved Original Claims." These claims will not be denied but may be '0' paid. The claims that are '0' paid may not be adjusted or resubmitted. Providers are responsible to implement a procedure to track and reconcile these claims pended for pre-payment review. Please see notices on www.lamedicaid.com concerning the newly implemented pre-payment review process.

REMINDER TO BAYOU HEALTH PLAN PROVIDERS

Claims for enrollees in the Prepaid Plans must be billed to and will be paid by the BAYOU HEALTH Plan. Claims for enrollees in the Shared Plans must be billed to Bayou Health Plan for pre-processing and then submitted by the Plan to Molina for adjudication and payment. Please refer to lamedicaid.com for the memo "Medicaid Billing Changes for Dates of Service Beginning February 1, 2012."