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 Extended Home Health Providers: Multiple Recipients in the Same Home
Effective for new prior authorizations with dates of service June 15, 2015 and after, when there are multiple recipients in the same home on the same date of service, providers should append the TT modifier to only one recipient's authorization and subsequent claims per date of service. The TT modifier would not be appended to the other recipient's authorization or claims on the same date of service. Claim submission must reflect the authorization for the specific recipient in the home on a date of service. This updated process will allow claims to process and reimburse correctly. Claims appended with modifier TT will be reimbursed at fifty percent of the fee on file.
This policy clarification only applies when there are multiple recipients in the same home on the same date of service using procedure codes S9123 and S9124.
For questions related to this information as it pertains to legacy Medicaid claims, please contact Molina Medicaid Provider Solutions at (800) 473-2783 or (225) 924-5040.
Attention New Opportunities Waiver, Children’s Choice Waiver, Residential Options Waiver Providers
Effective dates of service 9/1/15, Louisiana Medicaid will no longer accept the deleted modifier 'RP' for parts related to repairs of DME equipment for Procedure code T2029. Providers should begin using modifier 'RB' (Replacement of a part of a DME furnished as part of a repair) in these instances. Please make the necessary changes in your procedures and systems to ensure that you are requesting PA and billing with the new modifier.
ATTENTION PROVIDERS OF ‘TAKE CHARGE PLUS’ SERVICES
CORRECTIONS TO CLAIMS PROCESSING
The following corrections have been made to the Take Charge Plus program’s claims processing:
- To allow Affordable Care Act enhanced payments that denied incorrectly for edit 251(deny for diagnosis).
- To allow mid-level providers to be reimbursed 100% of the physicians’ fee on file for administered injections, LARCs, immunizations, and EPSDT preventive medical screenings.
- To allow FQHCs, RHCs, and American Indian “638” clinics to be reimbursed at fee for service rates.
- To allow previously denied outpatient ambulatory surgery claims to process and reimburse correctly.
Impacted claims will be recycled on the 08/18/15 Remittance Advice (RA).
For questions, please contact Molina Medicaid Services at (800) 473-2783 or (225) 924-5040.
Attention Durable Medical Equipment Providers
Effective dates of service 9/1/15, Louisiana Medicaid will no longer accept the deleted modifier 'RP' for parts related to repairs of DME equipment. Providers should begin using modifier 'RB' (Replacement of a part of a DME furnished as part of a repair) in these instances. Please make the necessary changes in your procedures and systems to ensure that you are requesting PA and billing with the new modifier.
For questions related to this information as it pertains to Legacy Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
Attention ALL Adult Day Health Care (ADHC) Providers
Due to requests from providers, the billing cycle for ADHC is changing from the monthly LTC billing cycle to weekly billing.
- The last monthly cycle ADHCs will bill for are dates of service for the month of August 2015. Prior to going straight to a weekly billing cycle, there will be a transition period during September 2015. Please note the following: During this transition time ADHC providers may not begin to submit claims weekly until after the August monthly checkwrite of Thursday, September 10, 2015.
- With this transition to weekly billing, ADHC claims will begin being included in the DHH pre-payment review process. As with all other claims paid weekly, ADHC claims will pend with edit 241 (claims held for pre-payment review) for an additional week before being released for payment. This means providers that submit claims by 12 noon Thursday, September 17, 2015 will not receive reimbursement for those claims until the RA of September 29, 2015.
After the checkwrite of September 29, 2015, then ADHCs will be on the “regular” weekly checkwrite. At that time, ADHC providers should expect to see all approved claims pend for one additional week with the 241 pend edit.
Weekly checkwrites are on Tuesdays. Providers must ensure that they submit claims to Molina by Thursdays at noon in order for the claims to process and appear on the RA the following Tuesday. Because ADHC services are post authorized, ADHC providers should send information files to SRI at least two days prior to submitting claims to Molina.