RA Messages for April 13, 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
In correspondence sent
in September 2009, we notified providers that pharmacy claims billed for
recipients for palivizumab (Synagis) outside the RSV season would deny.
To override the claim, pharmacists will be required to submit paper
claims to Pharmacy Benefits Management, P.O Box 91030, Baton Rouge, LA
70821-9030. For documentation pharmacists will need a prescription
handwritten in the prescriber's handwriting on the prescription.
Providers may call 225-342-9768 with questions.
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.
Effective with dates
of service on or after January 01, 2010, the reimbursement rates for
some laboratory and radiology services for Outpatient Hospital providers
are reduced. The codes being reduced are the result of having a rate on
the Medicaid file that was in excess of the 2010 Medicare rate.
Providers began seeing these reductions on the RA of February 23, 2010.
Claims that were adjudicated prior to February 23, 2010, have been
systematically adjusted on this RA (4/6/10) and no action is required by
Any questions should be directed to Provider Relations.
CERTIFIED NURSE MIDWIVES AND OB PROVIDERS
BILLING INFORMATION UPDATE: FIRST ASSISTANT AT SURGERY
Effective with date of
service May 1, 2010, Certified Nurse Midwives (CNM) who perform as the
'first assistant surgery' are to use the "AS" modifier to identify these
services. This billing update for Certified Nurse Midwives is to provide
consistency in billing for non-physician providers who perform as the
first assistant in surgery. There is no change in reimbursement
methodology for CNM's. Questions concerning this update may be directed
to Unisys Provider Relations at (800) 473-2783 or (225) 924-5040.
According to the
latest CMS regulations for complying with 5010 electronic transaction
standards, entities must be ready to begin testing in early 2011. All
electronic transactions must be conducted using 5010 and NCPDP D.0
versions beginning January 01, 2012. Providers should check with their
clearinghouse, submitter or software vendor to determine the status of
their preparations for the 5010 standards. The implementation will most
likely require changes to the software and/or systems that you use for
billing payers, so it is important that you plan for these changes.
Unisys and DHH are working on preparations to be able to meet the date
for beginning 5010 testing. Also, we will periodically share resources
and post updates regarding our progress to the lamedicaid.com website
under the link titled HIPAA Information Center.
FAMILY PLANNING WAIVER - REIMBURSEMENT RATE
CUT FOR ALL FPW SERVICES
Due to budgetary
shortfalls, DHH has implemented a 5% reimbursement rate cut for ALL FPW
services. This rate cut has been implemented with an effective date of