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 http://www.lamedicaid.com/. 

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

ATTENTION PROVIDERS:

PAYMENT ERROR RATE MEASUREMENT (PERM) 2014 PROVIDER EDUCATION WEBINARS

The Centers for Medicare & Medicaid Services (CMS) will be hosting PERM Provider Education Conference Calls/Webinars this summer, to provide interactive sessions for providers of Medicaid and Children's Health Insurance Program (CHIP) services. Providers will be informed about PERM updates, trends and responsibilities. There will be opportunities to ask questions and provide feedback to CMS and your state representatives.

For Webinar details, refer to the March/April, 2014 Provider Update Article, located in the Provider portal at www.lamedicaid.com.

Attention Intermediate Care Facility Providers

Effective April 1, 2014 the Provider Fee for Intermediate Care Facilities (ICF) days will increase from $14.30 to $16.15 as allowed by Louisiana Revised Statute 46:2625. Future Quarterly Fee Reports issued by the Department will reflect this change. Medicaid is awaiting CMS approval for the rate increase. Once this increase is approved DHH will recycle claims to pay you the increased rate associated with the fee increase.

For further information regarding the ACA enhanced reimbursement, including applicable procedure codes, please visit http://www.lamedicaid.com/ACA/ACA.htm.

ATTENTION ALL PROVIDERS USING THE CMS 1500 02/12 FORM FOR CLAIMS SUBMISSION - DATA ENTERED IN FIELD 22

Professional providers were recently notified of the transition from the proprietary 213 Adjustment/Void Form to the CMS-1500 Form for adjusting and voiding claims. Field 22 on the CMS 1500 (02/12) is the location where providers should enter adjustment/void information. As this transition has occurred, we have found that some providers use this field for their internal record keeping by entering the ICN of a previous claim as a reference. In the past, Molina did not key data from Field 22, so if providers entered internal data in this field, it did not cause problems. Effective with claims submitted on or after June 6, 2014 (regardless of date of service), claims submitted with data in Field 22 that is incomplete adjustment/void information will deny with error code '013-ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID ICN'. Please discontinue using Field 22 on claims submissions unless the submission is an adjustment or void.

Attention Hospital Providers:

Effective June 20, 2014, hospitals will receive an additional payment for the insertion of long-acting reversible contraceptives (LARCs) for women newly post-partum prior to discharge. The payment for the LARC will be equal to the fee on the DME fee schedule and will be in addition to the hospital's per diem payment. Providers may consult the DME fee schedule to see which LARCs are covered and their reimbursement.

For questions related to this information, please contact Molina Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Hospital Providers:

Effective June 1, 2014, Louisiana Medicaid is removing the hospital emergency room three visit limit per calendar year. System changes have been completed so all claims for dates of service on or after June 1, 2014 will process correctly in reference to this change.

For questions related to this information, please contact Molina Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS:

The Professional Services Fee Schedule has been updated to reflect new HCPCS codes for 2014. This completes the annual HCPCS update for 2014. Claims that denied due to the use of the 2014 codes prior to their addition to the procedure file will be systematically reprocessed on the Remittance Advice (RA) of June 10, 2014. No action is required by providers.

For questions related to this recycle, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.