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 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.
ATTENTION ALL PROVIDERS
CLAIMS VOIDED DUE TO TIMELY FILING ERROR
Based on extensive review, DHH has identified specific fee-for-service claims where the one (1) year timely filing limit was incorrectly applied during claims processing, and determined that some claims were paid in error. The review period covers fee-for-service claims received from December 2012 to September 2014.
In April 2015, Providers were notified by RA messages and by direct mail-outs that they were identified as being paid for inappropriately timely filed claims. Providers whose claim totals were less than one-thousand ($1,000) dollars were voided during the months of April and May 2015.
Providers whose claim total was one-thousand ($1,000) dollars and greater were given three options to address their claims, and if no choice was made, were informed that claims would be systematically voided within 30 days of the notice.
DHH has delayed the voiding of identified claims to allow for a secondary review of this issue. Based on this re-review, it was determined that all initial findings were correct, except for approximately thirty-six (36) claims. Therefore, affected providers will receive corrected notification by direct mail-out.
Providers originally identified who responded by choosing a specific option and those providers who did not chose an option as previously notified, your claims will be systematically voided on the RA of April 26, 2016. These actions will be based on the original letters of notification. No further notification will be transmitted.
Voided claims can be identified on the RA by the Internal Control Number (ICN) of the claim line, which will have a Julian date (the first 4 digits of the ICN) of 6108 (Sunday, April 17, 2016).
We apologize for this error, and for any inconvenience this may cause. Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 should you have questions regarding this notice.
ATTENTION LTC PROVIDERS
NATIONAL HEALTHCARE DECISIONS DAY IS APRIL 16, 2016
CONVERSATIONS CHANGE LIVES: TALK TO YOUR RECIPIENTS ABOUT
ADVANCE CARE PLANNING
Please refer recipients, employees and caregivers to www.la-post.org for information about advance care planning and resources necessary to make educated decisions about end-of-life care. Should you have questions regarding this letter, please contact Molina Provider Relations at 1-800-473-2783 or refer to www.lamedicaid.com.