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
ATTENTION PROFESSIONAL SERVICE PROVIDERS AND
DIABETES SELF MANAGEMENT TRAINING (DSMT)
Effective February 20, 2011, Louisiana Medicaid will
provide coverage for Diabetes Self-Management Training services rendered
to Medicaid recipients diagnosed with diabetes. For coverage details and
policy information, please refer to www.lamedicaid.com. Providers should
contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040
with billing or policy questions.
ATTENTION PROVIDERS OF KIDMED SERVICES
Louisiana Medicaid reminds KIDMED screening providers
of the KIDMED Screening Periodicity Policy, as published in the 2007
Louisiana Medicaid KIDMED Provider Training, page 10. Periodic
screenings performed on children less than two years of age must be at
least 30 days apart and periodic screenings performed on
children/adolescents who are two years of age or older must be at least
six months apart. Medically necessary preventive/well-child screenings
performed that do not meet this minimum number of calendar days/months
between screenings should be billed as KIDMED interperiodic screenings.
Example: A seven day old infant has a KIDMED medical screening performed
and three weeks later (21 calendar days) another screening is provided,
the second screening should be billed as an interperiodic screening as
it was performed less than 30 calendar days from the previous screening.
Contact Molina Medicaid Solutions Provider Relations at (800) 473-2783
or (225) 924-5040 should you have any questions.
ATTENTION HOSPITAL, PHYSICIAN AND BILLING
IMPORTANT INFORMATION CONCERNING
CHANGE IN PRECERTIFICATION REQUIREMENT FOR STERILIZATIONS
As we have implemented new policies related to
inpatient stays for deliveries, we have received requests from hospital
providers to remove the precertification requirement currently in place
for sterilizations performed on the first or second day of the inpatient
hospitalization. The edit that requires precertification for
sterilizations has been removed from the claims system. The removal of
this edit does not change the requirement for submission of OFS Form 96
or the hysterectomy acknowledgement form with the claim.
Please visit www.lamedicaid.com for the detailed
provider notice related to this change.
ATTENTION KIDMED PROVIDERS: NEWBORN SCREENING
Policy Update: Based on a Rule published in the
Louisiana Register Vol. 34, No. 03 March 20, 2008 by the Office of
Public Health, Louisiana Medicaid has revised the KIDMED policy related
to repeat newborn/neonatal heel stick screenings. Providers must
rescreen an infant whose newborn screening (e.g. PKU) was done prior to
24 hours of age, a change from the previous policy of prior to 48 hours
of age. These rescreenings are to be done at the first medical visit,
preferably between one and two weeks of age but no later than the third
week of life. To view the complete revised KIDMED Neonatal/Newborn
Screening policy and updated KIDMED Periodicity Schedule go to the
'KIDMED Newborn Screening' link on the home page of www.lamedicaid.com.
The updated KIDMED Periodicity Schedule can also be found on the KIDMED
website, www.la-kidmed.com, following the link for Publications & Forms.
Contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040
should you have any questions.