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.
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 ICF Providers, Nursing Home Providers and Hospice Providers
CMS required billing changes
Transaction standards updated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) with regard to ASC Xl2 Version 5010 require an attending provider be submitted on all institutional (format UB-04) claims. Effective July 1, 2015, all claims submitted for payment must identify the attending physician and all appropriate blocks on the claim form must be completed with the attending physician's identifying information. There will be no exceptions to this change. An edit will be put into the system to deny/reject any and all claim forms with missing required information.
Please visit www.lamedicaid.com for detailed provider notices concerning these changes.
ATTENTION PROFESSIONAL AND HOSPITAL PROVIDERS
BILLING RADIATION ONCOLOGY SERVICES FOR MEDICARE CROSSOVER CLAIMS
Clarification on 'G' Code Billing
On May 15, 2015, DHH published a notice informing providers that the appropriate procedure codes to bill Louisiana Medicaid for certain radiation oncology services are CPT codes 77385-77387. The notice also indicated that the "G" codes currently used by Medicare are not payable by Louisiana Medicaid.
Based on updated information, DHH has determined that HCPCS codes G6002 – G6015 currently used to bill Medicare for these services will be loaded on the Medicaid file as payable for Medicare Crossover claims only. This will prevent the outright denial of claims where Medicare is the primary payer. The 'G’ codes will not appear on the published Medicaid fee schedule due to the fact that they are non-payable for straight Medicaid claims. Medicare cross-over claims for HCPCS codes G6002-G6015 with dates of service January 1, 2015 forward that were previously denied will be recycled. The recycle is expected to occur within the next few weeks. No action is required by providers.
Please remember that these "G" codes remain in non-pay status for Medicaid primary claims, and providers must bill the appropriate CPT codes for Medicaid services. Providers may resubmit straight Medicaid claims using the appropriate CPT codes for radiation oncology services for dates of service January 1, 2015 forward that denied due to the use of the 'G’ codes.
Please contact Molina Provider Relations (800)473-2783 or (225) 924-5040 for questions.
Attention: All Providers
All providers should now use the current TPL update form entitled “Medicaid Recipient Insurance Information Update” form, located at www.lamedicaid.com. Directions for locating the form are provided below. Providers should fax the form to the correct Bayou Health Plan (BHP) for each Medicaid recipient.
Beginning July 1, 2015, the Department of Health and Hospitals (DHH) will no longer forward the TPL update forms received on Bayou Health Plan recipients to the applicable Bayou Health Plan (BHP).
If there is no medical insurance on the DHH/BHP file for the member, submit the claim to the BHP as secondary with the medical insurance information. The Bayou Health Plan will process the claim accordingly as the secondary payer and add the TPL information to the BHP/DHH file for future claims.
If the member has medical insurance information on the DHH/BHP file and it differs from the information that the PROVIDER has, the PROVIDER must submit the medical insurance information in which the member is enrolled and call the BHP call center or fax the TPL update form directly to the BHP for TPL updates to occur.
|Amerihealth Caritas LA
|Aetna Better Health
|LA Healthcare Conn
If the recipient is still enrolled in traditional Medicaid (no BHP managed care plan), the form should be faxed to DHH.
All previous forms are now obsolete and should no longer be submitted.
The new form can be found at www.lamedicaid.com Click on Forms/Files/User Manuals on the left navigational bar. Then, click on Online Forms. Scroll down to Medicaid Recipient Insurance Information Update Form - Private Insurance Plans and Medicare Advantage Plans. Fill in form, print and fax to the plan or DHH.