RA Messages for May 19, 2009
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.
Detailed LMAC changes
are posted on www.lamedicaid.com.
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
HOSPITAL PROVIDERS OFOUTPATIENT TAKE CHARGE (FAMILY PLANNING WAIVER)
note that the only codes payable in combination with HR490 (outpatient
ambulatory surgery) for TAKE CHARGE recipients are 58301, 58600, 58615,
58670, and 58671. Any HCPS other than these will deny when billed in
combination with HR 490.
INDEPENDENT LABORATORIES AND PROFESSIONAL SERVICES PROVIDERS
Updates have been made to the
procedure file related to CPT codes 83913 (Molecular Diagnostics...) and
86357 (Natural Killer Cells...). A recycle of affected claims is
complete and providers should see the recycled claims on the RA of May
12, 2009. No action is required by providers.
To maintain compliance with CMS guidelines in not exceeding the Medicare
reimbursement rate for clinical laboratory procedures, Louisiana
Medicaid's reimbursement for CPT codes 80047 (Basic Metabolic Panel...)
and 82962 (Glucose, blood...) was updated effective with date of service
January 1, 2009. Claims paid at the previous rate were systematically
adjusted and those adjustments should appear on the RA of May 12, 2009.
No action is required by providers.
March 30, 2009, HMS assumed the responsibility of updating the TPL
Resource Files for recipients with private insurance and Medicare
Advantage Plans. Prior to this transition to HMS, providers were given
the option to either submit the form via fax or to continue to mail the
form with the affected claims to the TPL Unit. Effective immediately:
(1) All TPL update requests for private insurance and Medicare Advantage
Plans must be submitted to HMS. The HMS update form must be FAXED to HMS
at 1-877-204-1325. (2) All TPL update requests for traditional Medicare
should continue to be FAXED to the DHH TPL Unit at 225-342-1376. In each
instance, an EOB or carrier letter supporting the requested update
should be included when/if available. Providers should discontinue
submitting claims with the TPL Information Update form. Any claims
submitted with these requests will not be processed; they will be
considered documentation only. Processing of your requests should only
take one week. Providers should hold any and all claims until the
recipient file is updated, then submit the claims through normal
processing channels. Providers should check this information through the
recipient eligibility options, e-MEVS, MEVS, or REVS, to ensure that the
update has occurred. The TPL update forms are located on the homepage of
the LA Medicaid website, www.lamedicaid.com, under the link, "TPL
Information." Questions concerning HMS updates (private insurance and
Medicare Advantage Plans) should be addressed to HMS at 1-877-204-1324.
Questions concerning DHH updates (traditional Medicare) should be
addressed to the DHH TPL Unit at 225-342-8662.