RA Messages for March 30, 2010
PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
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
PHARMACISTS AND PRESCRIBING PROVIDER
Corrections to the
recently mailed Preferred Drug List (PDL) are:
Page 7, Insulins &
Related Agents, Levemir should be on "Drugs on PDL". Page 8, Proton Pump
Inhibitors, Kapidex name has changed to Dexilant. The Preferred Drug
List (PDL) will be updated on
Notice to all enrolled
Direct Service Providers with the following provider types: Adult Day
Health Care (ADHC), EDA Waiver - Companion Services, Environmental
(Home) Modifications (Environment Accessibility Adaptations), Personal
Emergency Response System (PERS) and Long Term Personal Care Services (LTPCS).
It is the responsibility of your agency to insure the accuracy of the
Freedom of Choice Lists by updating and maintaining your agency
information that is presented to users via the Provider Locator Tool (PLT).
In order to access and use the PLT update feature, providers must
register and obtain a valid account at
www.lamedicaid.com. The PLT
system can be accessed at
www.dhh.la.gov/ and through a link on the OAAS website.
This is clarification
on the necessity for hospitals to split bill inpatient claims:
Hospitals are required to split bill their inpatient claims when 1) the
hospital changes ownership, or 2) at the end of the hospital's fiscal
year, or 3) if total charges on the claim exceed $999,999.99.
Hospitals have discretion to split bill their claims as warranted by
other situations that may arise.
Any questions should be directed to Provider Relations.
LABORATORY, RADIOLOGY, AND ASC (NON-HOSPITAL) PROVIDERS
IMPLEMENTATION OF REIMBURSEMENT RATE REDUCTIONS
Effective with dates
of service on or after January 22, 2010, the reimbursement rates for
laboratory and radiology services are reduced by 4.42% of the fees on
file as of January 21, 2010. Effective with dates of service on or after
February 5, 2010, the reimbursement rates for Ambulatory Surgical
Centers (ASC) are reduced by 5% of the fees on file as of February 4,
2010. Refer to the emergency rules published on the Office of State
Register's website (http://doa.louisiana.gov/osr/).
Providers should reference the link entitled "Professional Services,
Laboratory, Radiology and Ambulatory Surgical Centers (ASC) Fee
Schedules" under the "Fee Schedules" link on the homepage of the LA
Medicaid website (www.lamedicaid.com) for the most current fees.
Providers will begin seeing these reductions on the RA of March 23,
2010. Claims that were adjudicated prior to March 23, 2010, will be
systematically adjusted and no action is required by providers. Continue
to monitor future RAs for updates regarding these adjustments.
There was an error
when printing the remittance advices dated 3/16/2010, therefore, we are
reprinting and mailing a corrected version to all providers. Once you
receive the second version, please destroy the first one. The error
involved the shifting of payment information to the right and the
truncation of the internal control number. There was no error in
payments. The electronic version of remittances (835 files) did not have
any issues. We regret any inconveniences this may have caused.
PROVIDERS THAT SUBMIT MEDICARE PART A CROSSOVER CLAIMS
Effective with date of
processing March 23, 2010, LA Medicaid will begin processing Medicare
Part A claim adjustments that electronically cross to Medicaid from the
Medicare carrier through GHI (the Coordination of Benefits
Administrator). It will no longer be necessary for providers to
routinely initiate submission of Medicare adjustments as paper claims
with EOMBs attached. Any adjustments received electronically from GHI
between March 2nd and March 23rd will be processed on March 23rd and
will appear on your RA of March 30, 2010. Thereafter, electronic
adjustments will be processed as they are received from GHI. Of course,
if for any reason an adjustment does not electronically cross to
Medicaid through GHI, providers must submit them for processing using
the process previously in place. As always, providers should allow ample
time for Medicare claims, including adjustment claims, to be processed
by Medicare and electronically cross to Medicaid before taking action to
submit a claim. Work will begin immediately to allow Medicare Part B
claim adjustments to be electronically accepted from GHI, also. You will
be notified of the effective date once these changes are in place.
Questions concerning this transition may be directed to Unisys Provider
Relations at (800) 473-2783 or (225) 924-5040.
ATTENTION PROVIDERS: CLAIMCHECK
There is an additional provider notice dated March 19, 2010, regarding
the implementation of 'ClaimCheck' posted to the Medicaid website.
Providers are directed to information and updates regarding 'ClaimCheck'
via the specific 'ClaimCheck' link at www.lamedicaid.com. Providers
should visit this link frequently for the most current information on
the upcoming 'ClaimCheck' claims editing implementation.