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
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
PAYMENT ERROR RATE MEASUREMENT (PERM) 2017 IS NOW IN PROGRESS
Louisiana Medicaid is mandated to participate in the Centers for Medicare and Medicaid (CMS) Payment Error Rate Measurement (PERM) program which will assess our payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your organization will soon receive a Medical Records Request from the CMS review contractor, CNI Advantage.
Please be advised that sampled providers who fail to cooperate with the CMS contractor by established deadlines may be subject to sanctioning by Louisiana Medicaid Program Integrity through the imposition of a payment recovery by means of a withholding of payment until the overpayment is satisfied, and/or a fine.
Please be reminded that providers who are no longer doing business with Louisiana Medicaid are obligated to retain recipient records for 5 years, under the terms of the Provider Enrollment Agreement.
For more information about PERM and your role as a provider, please visit the Provider link on the CMS PERM website: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/Providers.html.
ATTENTION PROVIDERS OF HOSPICE SERVICES:
Hospice Rate Adjustment: Federal Fiscal Year (FFY) 2017
Louisiana Medicaid has updated its published fee schedule to reflect the adjusted reimbursement rates and Metropolitan Statistical Area (MSA) codes for the provision of Hospice services as determined by CMS for FFY 2017. The updated rates and MSA codes are effective for dates of service on or after October 1, 2016.
Providers should begin submitting claims using the updated MSA codes for dates of service on or after July 1, 2017. Providers may resubmit previously paid claims for dates of service October 1, 2016 through June 30, 2017 with the corrected MSA codes for payment adjustment.
For questions regarding this message and/or fee for service claims, please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.
Updates to Healthy Louisiana related to systems and claims processing changes are plan specific and are the responsibility of each health plan. For questions regarding Healthy Louisiana updates, please contact the appropriate health plan.
EarlySteps PT and OT Code Changes
Effective with date of service January 1, 2017, the previous CPT codes for Physical Therapy (PT) and Occupational Therapy (OT) evaluations (97001 and 97003, respectively) were deleted and each replaced with three new CPT codes which designate the complexity level of the evaluation.
The reimbursement rates across the new complexity levels remain the same as the previous codes and are determined by the type of service and place of service modifiers. In EarlySteps, these evaluations are used primarily for single domain assessments. The fee schedule can be found at: http://www.lamedicaid.com/provweb1/fee_schedules/feeschedulesindex.htm.
Providers are reminded that the evaluation report should now reflect the complexity level as part of the documentation requirements. Refer to recommendations provided by the American Physical Therapy Association and American Occupational Therapy Association guidance for determining the complexity level and appropriate documentation requirements. Please contact your EarlySteps regional coordinator for questions.
Professional Component of Clinical Laboratory Services – Fee Reimbursement Changes
Under Federal regulation, state Medicaid agencies are prohibited from reimbursing providers of clinical laboratory (lab) services at a higher rate than the Medicare allowable rate. In accordance with this regulation, clinical lab reimbursement rates were updated earlier this year and a recycle of clinical lab services was performed in May. Since that time, the fee for the professional component of a few additional lab services has been updated.
Clinical lab claims for dates of service on or after January 1, 2017 where the previous reimbursement exceeded the Louisiana Medicare allowable rate will be systematically recycled on the remittance of July 25, 2017 without any action required by the provider.
Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 if there are questions related to this matter for fee for service claims.