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. 

ATTENTION PHARMACY PROVIDERS

Claims for Palivizumab will be able to be processed electronically through Point of Sale through Friday, April 15, 2011. Effective April 16, 2011 claims for Palivizumab will require paper claims.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
PROCEDURE CODES PAYABLE TO PODIATRISTS

Effective January 1, 2011, procedure codes 97597 and 97598 (Debridement, open wound, including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface areas) are payable to podiatrists. The system has been updated to reflect this change. Claims for dates of service January 1, 2011-April 4, 2011 that were adjudicated prior to April 5, 2011, will be systematically adjusted. Continue to monitor future RAs for details regarding when the recycle of these claims will take place. Please contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning this issue.

PROFESSIONAL SERVICES PROVIDERS:
'DUPLICATE' DENIALS AND MODIFIER UPDATE

Revisions have been made to the complex duplicate logic in the claims processing system. This revision is intended to address the use of many anatomical 'site-specific' and 'repeat procedure' modifiers. Along with the 'site-specific' modifiers, modifiers -76 (Repeat procedure or services by same physician or...) and -77 (Repeat procedure or service by another physician or...) will be recognized (see the ClaimCheck webinar presentation information under the ClaimCheck button on www.lamedicaid.com for a listing of the anatomic 'site-specific' modifiers). When these modifiers are used appropriately, the "exact duplicate" denials related to error 813 should be reduced. Providers are reminded that improper use of modifiers to bypass claim editing solely to maximize reimbursement will be subject to review and administrative sanction by Louisiana Medicaid. Additionally, as indicated in provider agreement provisions, providers are to report and refund any and all overpayments.

To reduce the administrative burden for providers, claims with dates of service July 1, 2009, and forward that included these 'site-specific' or the 'repeat' modifiers and previously received a 'duplicate' denial, have been recycled. This recycle appears on the RA of April 5, 2011. Providers should expect that some of the claims will continue to deny for the same error, especially when there have been multiple resubmissions. When applicable, some claims may deny for a different reason. For questions related to this update and recycle, please contact Molina Provider Services at (800)-473- 2783 or (225)-924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
ALCOHOL AND/OR DRUG SCREENING/BRIEF INTERVENTION CODES

Effective April 1, 2011, Louisiana Medicaid will provide coverage for alcohol and/or drug screening and brief intervention for pregnant women. The system has been updated to reimburse for the billing of HCPCS codes H0049 (Alcohol and/or Drug Screening) and H0050 (Alcohol and/or drug services, brief intervention per 15 minutes). These codes are only reimbursable when billed with a -TH modifier. Reimbursement for these codes is restricted to once per pregnancy. Providers should monitor www.lamedicaid.com and weekly RAs for updates and future policy regarding these services. Providers should contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with billing questions.