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 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)
SURGICAL CENTER (ASC), and OUTPATIENT HOSPITAL SERVICES
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.
EFFECTIVE DATE FOR THE COMMUNITY CHOICES
Implementation of the new Community Choices Waiver that will
replace the current Elderly and Disabled Adult (EDA) Waiver will be October 1,