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
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
BILLING FOR RECIPIENTS ENROLLED IN A BAYOU
HEALTH SHARED PLAN
The following services are not provided by the Shared
Plans and will continue to be prior authorized and/or paid through
Dental, Pharmacy, Waiver services, Durable Medical
Equipment, Long-Term Personal Care Services, EPSDT Personal Care
Services, Hospice, Emergency and Non-Emergency Transportation Services,
Nursing Facility, Intermediate Care Facilities for the Developmentally
Disabled, Specialized Behavioral or Mental Health professional services,
Case Management, Adult Day Health Care, EPSDT Health Services and Early
Steps case management and medical services.
All other services must be billed to the BAYOU HEALTH Shared Plan the
recipient is enrolled with.
BILLING FOR RECIPIENTS ENROLLED IN A BAYOU
HEALTH PREPAID PLAN
The following are services not provided by the
Prepaid Plans and will continue to be prior authorized and/or paid
Dental, Pharmacy, Waiver services, Long-Term Personal
Care Services, EPSDT Personal Care Services, Hospice, Nursing Facility,
Intermediate Care Facilities for the Developmentally Disabled,
Specialized Behavioral or Mental Health professional services, Case
Management, Adult Day Health Care, EPSDT Health Services and Early Steps
case management and medical services.
All other services must be billed to the BAYOU HEALTH Prepaid Plan the
recipient is enrolled with.
THE FOLLOWING 5 MESSAGES ARE DIRECTED TOWARDS
BAYOU HEALTH PROVIDERS IN GSA-B (REGIONS 2, 3, AND 4)
1. ATTENTION LOUISIANA MEDICAID PROVIDERS
Effective for dates of service on or after 4/1/2012,
claims for Medicaid State Plan Services provided to BAYOU HEALTH Plan
members must be submitted to the Health Plan the member is linked to. If
they are billed directly to Molina, the claims will deny, advising you
to submit the claim to the Health Plan. Claims for carved out services
not covered under BAYOU HEALTH Plans will continue to be billed to
Molina. For further information, visit the website at
www.makingmedicaidbetter.com. Click on the Providers link, and
review the list of carved out services located on the 'Medicaid Provider
Billing Changes for Dates of Service Beginning April 1, 2012' document.
2. ATTENTION PRIMARY CARE PROVIDERS (PCPs)
Have you enrolled with a BAYOU HEALTH Plan yet? If
not, starting 4/1/12, you will no longer receive reimbursement for
providing services to Louisiana Medicaid recipients enrolled in a BAYOU
HEALTH Plan unless you have contracted with or made other arrangements
with a BAYOU HEALTH Plan. For further information, visit the website at
www.makingmedicaidbetter.com or participate in daily phone calls
being held Monday through Friday with DHH by calling 1-888-278-0296,
3. ATTENTION LOUISIANA MEDICAID PROVIDERS
The CommunityCARE and KIDMED programs are ending
statewide with the implementation of BAYOU HEALTH. As BAYOU HEALTH
phases into a Geographic Service Area (GSA), CommunityCARE and KIDMED
linkages for enrollees residing in the GSA will terminate.
There will be no new CommunityCARE or KIDMED provider enrollment
applications processed. Provision of EPSDT screening services for KIDMED
enrollees transitioning into BAYOU HEALTH will be the responsibility of
the individual Health Plans.
Existing PCPs are notified of the procedure for ensuring uninterrupted
medical care for transitioning CommunityCARE/KIDMED enrollees as BAYOU
HEALTH implementation begins in the GSA. Notices for GSA B may be viewed
4. ATTENTION COMMUNITYCARE PROVIDERS
Current CommunityCARE Primary Care Providers (PCPs)
that intend to continue rendering care to Louisiana Medicaid recipients
as PCPs in the BAYOU HEALTH program must ensure that each Health Plan is
provided with the 7-digit Medicaid legacy provider ID and corresponding
NPI enrolled in CommunityCARE. PCPs with CommunityCARE linkages at more
than one location must also include the appropriate 3-digit site number
for each enrolled location. This information is available on the
CommunityCARE CP-0-92 reports submitted for payment of the monthly
NOTE: Physician group practices, FQHCs, and RHCs must also provide the
Medicaid IDs and NPIs for the individual practitioners at each
For assistance verifying the enrolled Medicaid legacy provider ID, PCPs
may also contact the CommunityCARE contractor at 1-800-259-4444, option
5. VERIFYING HEALTH PLAN & ELIGIBILITY
INFORMATION FOR BAYOU HEALTH MEMBERS
Effective 4-1-2012, REVS, MEVS, and E-MEVS
applications will show the name of the BAYOU HEALTH PLAN and their phone
number for Medicaid recipients enrolled in BAYOU HEALTH. Enrollment in a
BAYOU HEALTH Plan is for the entire calendar month. This information
will be located where current CommunityCare PCP information is, and will
no longer contain the PCP name. You may obtain PCP information from the
BAYOU HEALTH Plan.
TO BAYOU HEALTH PROVIDERS ONLY IN GSA-A
(Regions 1 and 9)
AND GSA-B (Regions 2, 3, 4)
UPDATE TO VERIFYING FUTURE MONTH HEALTH PLAN & ELIGIBILITY
INFORMATION FOR BAYOU HEALTH MEMBERS ONLY
DHH has completed revisions that will allow future
month Health Plan and eligibility information to be shown in MEVS and
e-MEVS. Revisions allow providers to obtain future enrollment
information for dates of service up to 3 months. However, Plan
Enrollment into a BAYOU HEALTH Plan may be prospective, and a
recipient's eligibility for coverage under a Plan may be subject to
change. Therefore, to ensure that you are using accurate and up-to-date
eligibility information, it is your responsibility to re-check
eligibility status with e-MEVS and your MEVS vendor prior to and on the
date of service. If you fail to do so, and if you consequently provide
services to a recipient who is ineligible on the date of service, you
will not be paid for those services.
REMINDER TO BAYOU HEALTH PLAN PROVIDERS
Claims for enrollees in the Prepaid
Plans must be billed to and will be paid by the BAYOU HEALTH Plan. Claims for
enrollees in the Shared Plans must be billed to Bayou Health Plan for
pre-processing and then submitted by the Plan to Molina for adjudication and
payment. Please refer to lamedicaid.com for the memo "Medicaid Billing Changes
for Dates of Service Beginning February 1, 2012."
ATTENTION ALL PROVIDERS 2012 HCPCS UPDATE
The Louisiana Medicaid files have been updated to
reflect the new and deleted HCPCS codes for 2012. Providers began seeing
these changes on the RA of March 6, 2012. The Professional Services Fee
Schedule on the LA Medicaid website,
www.lamedicaid.com, has been updated. Claims denied due to use of
the new 2012 codes prior to their addition to our system will be
systematically adjusted on April 03,2012.
Providers will see denials of codes with 2012 date of service that were
deleted effective December 31, 2011. Those claims should be resubmitted
with the correct 2012 code.
Additionally, the "Assistant Surgeon/Assistant at Surgery Covered
Procedures List" under the 'Claimcheck' icon on the website will be
updated to reflect the addition of applicable 2012 procedure codes. As a
reminder, 'Claimcheck' uses the American College of Surgeons (ACS) as
its primary source for determining assistant surgeon designations.
ATTENTION LOUISIANA MEDICAID PROVIDERS
The Louisiana Medicaid Nurse Helpline will be discontinued
effective Monday, April 30, 2012, at 5:00pm. This service was provided through
the contract for administration of the CommunityCARE and KIDMED programs. BAYOU
HEALTH plans will assume responsibility for providing this service to their
members as the program is implemented into each of the three Geographic Service
Areas (GSA) of the state.
Members are to call:
Amerigroup - 1-800-600-4441
Community Health Solutions - 1-855-247-5248
LaCare - 1-888-756-0004
Louisiana Healthcare Connections - 1-866-595-8133
United Healthcare Community Plan - 1-866-675-1607
Providers in GSAs A and B should immediately remove all
references to the Louisiana Medicaid Nurse Helpline from patient literature and
office messaging. Providers in GSA C, the final area of the state scheduled for
BAYOU HEALTH implementation, must have this process completed by April 30th.
ATTENTION ALL PROVIDERS: POLICY CLARIFICATION
Breast reconstruction surgery performed after a
mastectomy is a covered service, but breast reconstruction to establish
symmetry with contralateral breast is not covered. Tattooing the areola
of the breast and reconstruction procedures to achieve symmetry of the
breasts will not be covered by Louisiana Medicaid.
ATTENTION ALL NON-EMERGENCY TRANSPORTATION
Claims for Non-Emergency claims and Prior
Authorization for these services were being denied erroneously effective
2/1/12 as a result of implementation changes for the BAYOU HEALTH Plan.
Corrections have since been made to correctly allow the claims to pay if
an appropriate Prior Authorization is on file. Claims that were
previously denied for February and March are being systematically
recycled for potential payment and will show up on the 4/10/12 RA.