RA Messages for
August 18, 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
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 PROFESSIONAL SERVICE PROVIDERS
BILLING DIAGNOSTIC HEART CATHETERIZATIONS
It has been brought to the Department's attention
that clarification is needed regarding the billing of a therapeutic
cardiovascular intervention on the same date of service as a coronary
angiography. This message is intended to provide clarification for
providers who perform and bill for these services.
Coronary angiography without concomitant left heart catheterization
should not be billed to report catheter introduction and position within
the vessel when performing a therapeutic cardiovascular intervention
(such as balloon angioplasty and intracoronary stent placement). This is
considered an integral part to the primary procedure; therefore, it
should not be reported separately.
The only instance when it would be appropriate to
report coronary angiography without concomitant left heart
catheterization on the same date of service as a therapeutic
cardiovascular intervention would be if a true diagnostic angiography
was performed, and documentation supports the performance and necessity
for the procedure. Instances which would be appropriate for separate
reimbursement include occasions in which no previous angiographic study
is available, insufficient previous angiography, or a change in the
patient's condition. In order to appropriately bill for both of these
services on the same date of service, providers should append the
coronary angiography with the appropriate modifier to identify it as a
distinct procedural service.
Providers are reminded that the medical record acts
as the only means to support services billed. If the medical record does
not support the necessity and performance of a true diagnostic
angiography, the claim for the angiography will be determined as an
overpayment and is subject to recoupment.
Please contact the Molina Provider Relations unit at (800) 473-2783 or
(225) 924-5040 with questions concerning this issue.