RA Messages for August 4, 2011

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 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.

DHH TO TRANSITION TO USING ONE TYPE OF ELIGIBILITY CARD

The Department of Health and Hospitals (DHH) currently issues two types of plastic swipe medical eligibility cards (MECs) for purposes of verifying Medicaid enrollment and service coverage or restrictions. A pink MEC is issued to women eligible for the TAKE CHARGE Family Planning Waiver which has a benefit package limited to only family planning services, and a white MEC is issued to individuals eligible for all other Medicaid eligibility programs.

Over the coming months, DHH will transition to the issuance of a white MEC for all Medicaid eligibility programs regardless of the scope of the benefit package. Therefore, it is important that providers verify eligibility and coverage limitations or restrictions on the date of service on all Medicaid enrollees by either logging in to the Louisiana Medicaid Provider Support Center on www.lamedicaid.com, or calling the Recipient Eligibility Verification System (REVS) at 1-800-776-6323. Failure to do so may result in denied claims.

ATTENTION INPATIENT ACUTE HOSPITAL PROVIDERS
CHANGE IN RETROSPECTIVE REVIEW PROCESS

In November of 2010, DHH changed the requirements for the retrospective review process for Acute Inpatient Hospital Providers. Since then, DHH has monitored this process and listened to the suggestions and concerns of the hospital providers. Beginning August 1, 2011, a new retrospective review process will be implemented. Please visit the Medicaid website at www.lamedicaid.com to review the amended process. Please note that this new process only applies to Acute Inpatient Hospitals and does not apply to Psychiatric, LTAC, or Rehab Hospitals.

ATTENTION PROVIDERS OF PRENATAL AND PEDIATRIC CARE SERVICES

Louisiana Medicaid reminds providers of the Medicaid Prenatal and Preventive Pediatric Care Pay and Chase policy, as published in the 2006 Louisiana Medicaid Basic Services Provider Training, page 40. This policy addresses certain prenatal and pediatric preventive care services including immunizations (see bullet #2 of the policy), when the Medicaid enrollee also has a private health insurance carrier.

Providers accepting primary health insurance and Medicaid as secondary coverage for a Medicaid recipient should follow the Pay and Chase policy for all services identified in the policy. If providers choose not to follow the pay and chase policy for services included in this policy, the recipient cannot be billed for Medicaid covered services. Example: A child requires a Medicaid covered childhood immunization(s) and has both private health insurance as well as Medicaid as secondary coverage. The Medicaid provider should use vaccines obtained from the Vaccines for Children (VFC) program to immunize the child and bill Medicaid directly. If the provider does not follow this policy and utilizes privately purchased vaccines, and if the private insurance carrier denies the immunization claim, Medicaid will not reimburse providers for the vaccine serum used and the provider cannot bill the recipient for the vaccine nor for the administration of the vaccine.

If a provider elects to not accept a recipient's Medicaid as secondary coverage, Louisiana Medicaid encourages providers to obtain signed documentation, prior to services being rendered, indicating the Medicaid recipient was made aware that the provider was not accepting Medicaid as secondary coverage, and that the recipient could be responsible for payment of services not covered by the private insurance.

Contact Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225) 924-5040 should you have any questions.

ATTENTION ALL PROVIDERS

The checkwrite schedule for the month of August 2011 is as follows:

Thursday August 4, 2011
Wednesday August 10, 2011 (Long Term Care and all other combined)
Thursday August 18, 2011
Thursday August 25, 2011

EDI cut-off is 10:00 AM on the Thursday preceding the check write date.

ATTENTION PROFESSIONAL SERVICE PROVIDERS
PHYSIATRISTS MANAGING INTRATHECAL BACLOFEN THERAPY

Effective with date of service August 1, 2009, Louisiana Medicaid reimburses physiatrists for intrathecal baclofen pump management. Services that may be provided by a physiatrist include pump analysis, programming, refill, and maintenance. Providers are encouraged to refer to the Current Procedural Terminology manual for instructions on how to bill for these services.

Please contact the Molina Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning this issue.

ATTENTION ALL PROVIDERS OF DURABLE MEDICAL EQUIPMENT

All providers who provide Durable Medical Equipment (DME) that are not exempted from accreditation should submit their documentation for accreditation by July 31, 2011. DME providers without certificate of accreditation on file by August 31, 2011, will have their provider numbers closed on that date.

Closed DME providers will have three months, or 90 days, to submit the documentation and retain their enrollment status in Louisiana Medicaid. After the 90 day period, a new enrollment packet will need to be submitted along with the accreditation documentation to reinstate their provider numbers.

ATTENTION HOSPITAL PROVIDERS
NATIONAL CORRECT CODING INITIATIVE (NCCI)
MODIFIERS FOR OUTPATIENT HOSPITAL SERVICES

Recently installed edits related to the incorporation of NCCI edits and methodologies for claims processing make use of various modifiers reported on claims to allow correct payment. We have modified our system to allow modifiers to be used on Outpatient claims in all four positions. With these changes we have systematically recycled all Outpatient claims that denied for one of the NCCI edits listed below in order to allow them to be processed with the modifier that was submitted on the original claims. The new edit messages that pertain specifically to the NCCI edits 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.'
992-'CCI: History procedure mutually exclusive to current-history
voided.'

These recycled claims will appear on the 08/04/11 RA. If you have any billing or policy questions, please contact Provider Relations at (800) 473-2783 or (225) 924-5040.