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
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 NURSING HOME ADMINISTRATIORS
As part of the budget reduction measures by the Department of
Health and Hospitals, Medicaid will no longer pay co-insurance on therapy
services (physical therapy, occupational therapy and speech/language therapy) on
Medicare/Medicaid Cross-over claims effective with Date of Service July 1, 2012.
Claims billed on or after this date of service will '0' pay with edit 384 -NOT
COVERED FOR NURSING HOME RESIDENT. If you have questions please contact Denis
Beard at 225-342-6116.
EHR INCENTIVE PAYMENT PROGRAM - UPDATE
Since January 2011, nearly 1,300 eligible medical professionals and
hospitals have received more than $120 million in incentive payments
through participation in Louisiana's Medicaid Electronic Health Records
(EHR) Incentive Payment Program. The EHR Incentive Payment Program is a
100% federally funded initiative that promotes the adoption and
meaningful use of certified EHR technology through the provision of
incentive payments to eligible professionals and hospitals. Eligible
professionals can receive a maximum of $63,750 in incentive payments
over a six-year period, and in 2011, the average payment to Louisiana's
participating hospitals was $1.1 million.
PROCEDURES: BILLING CLARIFICATION
When billing for bilateral procedures performed
during the same session (unless otherwise directed in CPT), providers
are to use the -50 modifier (Bilateral procedure) with the appropriate
CPT code and place a "1" in the units field of the claim form. The site
specific modifiers 'LT' (Left side) or 'RT' (Right side) may be used on
appropriate CPT codes only when services are performed on either the
right OR the left side. Providers should not use the 'LT' and 'RT'
modifier on the same procedure code instead of the -50 modifier. For
example, during the same session it is not appropriate to use the 'RT'
and 'LT' on CPT procedure code 69436 (Tympanostomy...) when performed
bilaterally. For questions related to this clarification, please contact
Molina Medicaid Solutions Provider Services at (800)-473-2783 or