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 http://www.lamedicaid.com/.
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 Providers: Medicaid RAC Provider Education Seminar
The Department of Health and Hospitals and Myers and Stauffer LC is hosting a Provider Education Seminar on the new Medicaid Recovery Audit
Contractor (RAC) program mandated by the Centers for Medicare and Medicaid Services (CMS). Seating for the seminar is limited and will be
reserved by registration only. The seminar will be streamed live for those who are not present at the seminar and recorded for future
viewing by those providers who cannot attend or view by live stream.
To reserve a seat, please register for the RAC Provider Education Seminar by emailing:
Please include specific questions you or your organization may have about the RAC in your email.
Date: September 18, 2013
Time: Seating begins at 8:30 a.m., seminar 9:00 a.m. - 11:00 a.m.
Location: 628 North 4th Street, Baton Rouge-1st floor, room 118
ATTENTION HOSPITAL PROVIDERS
It has been brought to the Department's attention that the fee schedules for outpatient hospitals had an
incorrect indicator displaying. The fee schedules incorrectly indicated that reimbursement for some procedure
codes were being limited to crossover claims only. This was an error on the fee schedules that is being fixed.
Claim reimbursement was not impacted by this error therefore no recycle/resubmission of claims is needed.
Attention Pharmacists and Prescribing Providers:
Pharmacy claims for shared health plan or legacy Medicaid recipients for combination acetaminophen products
will continue to deny when the dose of acetaminophen exceeds four (4) grams per day; claims for combination
aspirin products will still deny when the dose exceeds six (6) grams per day. Dosing will be accumulated
from all active prescriptions. The denial cannot be overridden through Point of Sale claims processing.
Attention Providers with Erroneously Denied or Pended Claims on July 30, 2013 RA Edits 043, 190, 200 and 201
On the check write dated July 30, 2013, we experienced a claims processing issue involving claims requiring prior
authorization. This caused some erroneous claim denials and pends. The identified edits associated with these
incorrect denials are 043, 190, 200 and 201.
We will reprocess these claims on the provider's behalf and will enter them into the claims processing system
with a new Internal Control Number (ICN) in order to capture the correct Prior Authorization number as originally
submitted on the claim. These reprocessed claims will not pend for pre-pay review. Original claims and
adjustments/voids will be included. They will be adjudicated in the check write dated August 6, 2013.
Claims related to this error that are pending for edit 190 (PA Number Not on File) and appear in the "Claims
in Process" section of the July 30th RA are being reprocessed with a new ICN. However, the pended claims with
erroneous PA numbers will continue to pend until they are systematically released. Since we are also
reprocessing these claims as original claims, you may see edit 190 denials in the remittances of August
6th or August 13th as these claims move through the system to final adjudication.
Please reconcile your claims against the reprocessed claims from the August 6th RA. If other claims appear to
have been denied due to this processing error or due to provider billing error, please resubmit any outstanding claims.
We regret any inconvenience this error has caused.
ATTENTION PROVIDERS: ADDITIONAL INFORMATION ON A SECOND CYCLE TO REPROCESS ERRONEOUSLY DENIED CLAIMS FROM THE JULY 30, 2013 RA
On August 1st, a notice was posted to providers concerning the fact that on the check write dated July 30, 2013, we experienced a claims processing issue involving claims requiring prior authorization. This caused some erroneous claim denials and pends. The identified edits associated with these incorrect denials were 043, 190, 200 and 201. These claims were reprocessed on the RA of August 6, 2013.
We have learned from providers that we failed to capture some claims that were affected by this error, and they were not included in the reprocessed claims on the August 6th RA. In order to make every effort to reprocess all of these erroneously denied claims, we are pulling and recycling additional claims from our processing cycles of July 19th through July 25th. These claims are being reprocessed this week, and will appear on the RA of August 12, 2013.
As before, we will reprocess these claims with a new Internal Control Number in order to capture the correct Prior Authorization number originally submitted on the claims that erroneously denied. These reprocessed claims will not pend for pre-pay review and will be adjudicated in the check write dated August 12, 2013.
Since some claims that were not initially reprocessed are included in this second reprocessing, you may see claims correctly deny again for either the same or a different but correct edit.
Following this recycle, if other claims appear to have been denied due to this processing error or due to provider billing error, please resubmit them. We apologize for this oversight and regret any inconvenience this error has caused.