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 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.
The Professional Services, Laboratory and Radiology, and Outpatient Hospital "Non-Ambulatory" Surgery Fee Schedules on the Louisiana Medicaid Website, www.lamedicaid.com have been updated to reflect the new 2015 procedure codes. The Outpatient Hospital "Ambulatory" Surgery Fee Schedules will be updated in the near future.
Providers should monitor their RA messages for additional information.
ATTENTION ALL PROVIDERS:
2015 HCPCS Claims Recycle/Fee Schedule Update
Claims that have been denied by legacy Medicaid due to use of the new 2015 codes not on file yet will be systematically recycled. Providers will see the recycle results on the RA of March 31, 2015. No action is required by providers.
The Professional Services, Laboratory and Radiology, and Outpatient Hospital "Non-Ambulatory" Surgery Fee Schedules have been updated on the Louisiana Medicaid Website, www.lamedicaid.com to reflect new 2015 procedure codes. The Department is working to get the Outpatient Hospital "Ambulatory" Surgery Fee Schedules updated as quickly as possible.
ATTENTION ALL MEDICAID PROVIDERS
Effective April 1, 2015, the Louisiana Medicaid web site will begin a transformation. The evening of March 31, 2015, a �facelift� will occur overnight! We will transition this site to a new look. The site becomes a part of the DHH Network, with the same color scheme and physical look of those web sites. The web site address, www.lamedicaid.com, will remain the same.
With this first phase of changes:
- The Banner previously run across the top of the screen becomes �Alerts� at the top of the Home page.
- Only 30 days of provider web notices will be maintained on the active Home page.
- Notices over 30 days old that are currently located on the Home page will either be moved to appropriate directory links or will appear below the Home page notices on a new link, Additional Web Notices.
- Notices initially housed on the Additional Web Notices link will be gradually moved from this link to the correct directory link.
- Ultimately, all notices will be on the active Home page for 30 days and then transferred to the appropriate directory link.
In a future phase of this transition, the directory links and sub-links will be re-named and re-organized for a more "user friendly" experience. During the coming months, please watch for the announcements concerning additional changes to the site.
We hope the changes we are making will have a positive impact for you, our users, and thank you for your patience as we move forward with this transformation.
For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
Thank you for your assistance in this matter.
Attention Durable Medical Equipment Prosthetics and Orthotics (DMEPOS) Providers
The DMEPOS Fee Schedule on the Louisiana Medicaid website,
have been updated to reflect the deleted and new 2015 HCPCS codes. The deleted codes removed from the DMEPOS Fee Schedule with the termination date of December 31, 2014:
- A-7043: Vacuum drainage bottle and tubing for use with implanted catheter
- L-7260: Electronic wrist rotator, Otto Bock or equal.
- L-7261: Electronic wrist rotator, for Utah arm.
Effective with date of service January 1, 2015, Louisiana Medicaid will cover the following CPT procedure codes:
- A4459: Manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type
- A4602: Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each
- A7048: Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each
- K0901: Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated
- K0902: Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated
- L3981: Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments.
- L6026: Transcarpametacarpal or partial hand disarticulation prosthesis, external power, self-suspended,
inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s).
- L7259: Electronic wrist rotator, any type.
- L8696: Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each
ATTENTION HOSPITAL PROVIDERS
BILLING LEGACY MEDICAID NEWBORN CLAIMS
Following the elimination of Inpatient Hospital Pre Certification requirements for Legacy
FFS Medicaid claims, claims billed with Revenue Codes 172-175 for newborn babies
have been identified as being incorrectly paid at a $0 amount. This issue has been
resolved to provide appropriate payments, and all claims previously billed with these
revenue codes will be recycled on the April 7th, 2015 RA.ulation
If you have questions about the contents of this RA, you may contact Molina Provider
Relations at (800) 473-2783 or refer to www.lamedicaid.com.
Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and
Effective April 8, 2015 clinical pre-authorization will be required for Androgenic Agents
(excluding oxandrolone), lvacaftor (Kalydeco®), and Roflumilast (Daliresp®). These claims will deny with EOB code 066 (Clinical Pre-Authorization Required). For more
information please refer to www.lamedicaid.com.
ATTENTION HOSPITAL PROVIDERS:
It was recently noted that code G0379 (Direct Refer Hospital Observation) was not included in recent changes to claims processing logic for observation services resulting in unintended claim denials. The claims processing logic has been corrected. Claims will systematically be recycled without any action required on behalf of the provider. Providers will see this on the April 7th RA
Providers should also note that the service limit for G0379 is 1(one) unit. The actual number of hours in observation is reported under a separate CPT (Current Procedural Technology) code.
Please contact Molina Provider Relations (800)473-2783 or (225) 924-5040 for questions.
ATTENTION PROVIDERS BILLING RADIOLOGY SERVICES TO BAYOU HEALTH SHARED PLANS
Systems logic for radiology claims has been revised to reimburse the number of units submitted up to the maximum allowed. Claims previously denied inappropriately have been identified and will be reprocessed on the 4/7/15 RA.