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 www.lamedicaid.com. 

 ATTENTION PROVIDERS OF RUM SERVICES

When it is necessary to bill a RUM claim for the same procedure code that is performed more than once on the same day (i.e. billing 2 of the same procedure code), the procedures must be billed on separate lines with 1 unit per line. It is necessary to use an appropriate modifier(s) appended to the claim line(s). Additionally, when it is appropriate to use more than one modifier per claim line, the modifier in the first position on each claim line must be different in order to prevent a duplicate denial (see example 2 below). The use of appropriate modifiers will allow legitimate multiple procedure claim lines to process without denying as a duplicate of the other claim line. [Ex. 1: Authorization requested and approved for two of code 73718 - CT lower extremity (right leg and left leg). Bill 73718 RT and 73718 LT.] [Ex. 2: Authorization requested and approved for two of code 73223- MRI any joint-upper extremity w/wo contrast (joint before and after pins placed). Bill 73223 RT and 73223 76 RT.] As this change was made to the system, claims without modifiers that were previously denied were recycled with a by-pass of the duplicate logic on a one-time basis in order to get previously submitted claims processed. The recycle occurred on the 06/07/11 RA. Providers that have received additional claim denials should resubmit the denied claim lines with appropriate modifiers in order for the claims to process correctly. Please contact Molina Provider Relations at (800) 473-2783 should you have questions related to billing these codes.

ATTENTION ALL PROVIDERS
NATIONAL CORRECT CODING INITIATIVE (NCCI)
PRACTITIONER,* AMBULATORY SURGICAL CENTER (ASC), and OUTPATIENT HOSPITAL SERVICES
PROCEDURE to PROCEDURE EDITS 

The Affordable Care Act of 2010 requires that States incorporate NCCI edits and methodologies for claims filed on or after April 1, 2011 for for dates of service on or after October 1, 2010. Effective for claims processed on the remittance date of June 21, 2011, Louisiana Medicaid is applying the mandatory procedure to procedure editing methodologies that are components of the NCCI editing. These will apply to practitioner,* ASC, and Outpatient Hospital services. Procedure to procedure edits are defined as pairs of HCPCS/CPT codes that should not be reported together. These NCCI edits are applied to services performed by the same provider for the same recipient on the same date of service. When appropriate, modifiers may be applied to further describe the clinical scenario. Louisiana Medicaid's claims processing system has been updated to accept all NCCI-associated modifiers. Providers may NOT bill recipients for services denied by NCCI edits. Providers could expect to see denials on procedures that may have previously paid when billed in the same manner. For NCCI edits, the decision on which procedure code of a code pair is payable was determined by CMS. CMS updates these edits quarterly. New edit messages that pertain specifically to the NCCI edits have been added.

Currently these are:

731-'CCI: Procedure incidental to another current procedure.'
759-'CCI: Procedure incidental to a procedure in history.'
982-'CCI: History procedure incidental to current-history voided.'
984-'CCI: Procedure mutually exclusive to another current procedure.'
989-'CCI: Procedure mutually exclusive to procedure in history.'
993-'CCI: History procedure mutually exclusive to current-history voided.'

The NCCI methodologies for the medically unlikely edits (MUE) for units of service will be implemented at a future date. These edits will also include durable medical equipment suppliers' claims. For additional information, please refer to prior NCCI notices on the Medicaid website www.lamedicaid.com dated March 15, 2011 and September 23, 2010. Providers are also encouraged to access information on the CMS website at www.cms.gov under the Medicaid NCCI link. (*Practitioners include those licensed medical professionals who submit claims to Medicaid using HCPCS/CPT codes.)  

IMPORTANT NOTICE TO ALL ORDERING AND RENDERING PROVIDERS OF
HIGH-TECH RADIOLOGY SERVICES
RADIOLOGY UTILIZATION MANAGEMENT (RUM)

Louisiana Medicaid has identified an issue related to the reimbursement of claims for Radiologic services, whereby claims were paid without an approved Prior Authorization on file. We have identified and corrected the logic that allowed these claims to pay and have identified those claims paid in error. These are claims that were paid against a valid Prior Authorization, but the specific line for the procedure code was either denied or withdrawn, but the claim still paid. The claims that were paid in error will be voided on the 07/05/11 RA. If you have any billing or policy questions, please contact Provider Relations at (800) 473-2783 or (225) 924-5040.

ATTENTION ALL PROVIDERS

For the month of July 2011, the check writes will be scheduled for Wednesday July 6th, July 13th, July 20th and July 27th. Direct deposit funds will be available on the Thursdays following the check write date. Please notify all of your billing personnel as well as business associates handling billing and/or remittance posting on your behalf. Long Term Supplemental Billing is scheduled for July 20th and July 27th. This change does not impact the regular EDI cut off dates and times, except for LTC supplemental billings.