RA Messages for August 31, 2010
PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
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
REGARDING RATE REDUCTIONS AND CLAIMS ADJUSTMENTS FOR
PROFESSIONAL SERVICES PROVIDERS
response to concerns received from professional services providers
affected by the rate reductions put in place over the last year, weekly
retroactive claims adjustments were postponed effective July 27, 2010.
The Department will resume these adjustments beginning in late
September. Providers should refer to www.lamedicaid.com on Tues, Aug 24,
2010 for a memorandum that will provide details. The memorandum provides
a means by which providers can inquire about an alternative payment
plan, request an estimated total dollar amount of the adjustment
balance, or to submit questions.
STANDING REHABILITATION CLINICS, OUTPATIENT
HOSPITAL REHABILITATION CENTERS AND HOME HEALTH PROVIDERS
It is no longer
necessary to include the PA-02 form with Prior Authorization requests
for physical, occupational or speech therapy to be provided in an
out-patient facility or in the recipient's home as long as the following
are included: a completed PA-01 form, a signed and dated prescription,
and a dated therapist's evaluation or current progress notes which
states the recipient's plan and lists the proposed goals. Effective with
date of processing July 19, 2010, Molina will no longer deny requests
for rehabilitation services due to no PA-02 form being submitted with
the PA packet. All Prior Authorization requests must still include for
processing the Therapist's Evaluation/ Progress Notes and the signed
Physician's Prescription for services.
FACILITIES AND RETAIL CONVENIENT CARE CLINICS
Effective with date of
service July 1, 2010, qualified providers may enroll in Louisiana
Medicaid with an Urgent Care Facility or Retail Care Clinic
subspecialty. Providers with Urgent Care or Retail Convenience Care
designation will no longer require the PCP's referral/ authorization to
be reimbursed by Medicaid. This requirement is being eliminated in order
to facilitate access to after-hours medical care and reduce costs
associated with Emergency Room utilization for non-emergent conditions.
Requirements for these provider subspecialties and instructions for
enrolling with this subspecialty can be found on the Medicaid provider
website, or by contacting Provider Relations at (800) 473-2783.
IMPLEMENTATION OF JANUARY 2010 PHYSICIAN ADMINISTERED DRUGS
The reimbursement rate
adjustments for physician administered drugs effective with date of
service January 22, 2010, have been implemented. Providers will begin
seeing these reductions on the RA of August 17, 2010. Refer to the
Office of the State Register's website at
for published rules detailing these reductions. Providers should visit
the LA Medicaid website, www.lamedicaid.com, for updates to the
Professional Services Fee Schedule. The adjustment of claims for
physician administered drugs paid between January 22, 2010 - August 17,
2010 will be included in the upcoming adjustment of professional
services claims for the August 2009 and January 2010 rate reductions.
There is still a delay in implementing these adjustments as we assess
available options for providers. Continue to monitor future RAs for
details regarding when the recycle of these claims will take place.
Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040
with questions related to the implementation of the rate reductions.
DME PROVIDERS - INCLUDING PHARMACIES PROVIDING
In the near future, LA
Medicaid will require DME providers to submit NDC information on PA
requests and associated claims for enteral therapy products. This
requirement applies to all DME providers, including pharmacies that
dispense the DME supplies to Medicaid recipients. Please visit the LA
Medicaid website, www.lamedicaid.com, frequently for the effective date,
the list of products and associated NDC data, and other detailed
information related to this requirement.
HOSPITAL PROVIDERS AND PHYSICIAN PROVIDERS
Effective August 30,
2010, two significant changes will take place concerning hospital policy
and Precertification requirements:
1. Change in policy for the outpatient 24 hour rule.
2. Change in requirement for Hospital Precertification of deliveries and
accompanying billing changes.
Please visit www.lamedicaid.com for detailed provider notices concerning
identified a problem that inadvertently required prior authorization for
permanent teeth that are not covered for procedure code D3220
(Therapeutic Pulpotomy). This code is only reimbursable for Primary
Teeth letters A-T, without prior authorization. Pulpotomies for
permanent teeth are reimbursable under procedure code D3222, requiring
prior authorization. This problem only affected those dental claims
which were processed July 29, 2010 through August 6, 2010. Program
changes have been implemented to correct this problem, and all claims
that were denied within the time period mentioned will be automatically
recycled by Medicaid and appear on a future remittance advice. Should
you have any questions, you may contact Provider Relations at (800)
473-2783 or (225) 924-5040.
Effective August 24,
2010, two changes are being made to the LA Medicaid paper remittance
advices (RA). The following changes are being made to address recent
concerns raised by providers:
1) A change has been made to display a "NET" amount for Adjustment/
Previously Paid claims. The "NET" amount is the calculated difference
between the Previously Paid amount and the Adjusted amount. The "NET"
amount will display below the payment in the Adjustment section of the
RA. If the NET adjusted amount is less than the original payment, a
minus (-) sign will display after the difference posted. This is
intended to help address provider's concerns with reconciling their RA
when adjustments are made as a result of rate reduction.
2) The procedure description has been shortened to accommodate
displaying up to 4 modifiers on the RA. In circumstances where it is
necessary to use multiple modifiers, all modifiers will appear on the RA
with the procedure code.
Should you have questions concerning this change, please contact
Provider Relations at (800) 473-2783 or (225) 924-5040.
PRENATAL CARE PROVIDERS
MEDICAID PROFESSIONAL SERVICES PROGRAM COVERAGE OF '17P'
Effective with date of
service September 1, 2010, the Louisiana Medicaid Professional Services
program covers the weekly intramuscular injections of 17 Alpha-Hydroxyprogesterone
Caproate (17P) for use in pregnant women with a history of pre-term
delivery before 37 weeks and no symptoms of pre-term labor in the
current pregnancy. Detailed policy is available on the Medicaid website
at www.lamedicaid.com, then using the links for 'Training/Policy Updates
- 2010 Policy Updates - Professional Services Program.' The complete
policy is to be reviewed and followed by providers using this medication
in the treatment of their patients. For further questions, please
contact Molina Provider Relations at (225) 924-5040 or (800) 473-2783.
IMPLEMENTATION OF AUG 1, 2010 RATE REDUCTIONS
The Aug 1, 2010 rate
reductions for inpatient and outpatient hospital services have been
implemented. Providers will begin seeing these reductions on their
remittance advices beginning with Aug 31, 2010. Claims for dates of
service after Aug 1, 2010 that have already been adjudicated will be
systematically adjusted on the remittance advice dated Sep 7, 2010 and
no action will be required by providers. The exception to this is if an
inpatient stay spans the Aug 1, 2010 date, these claims then would have
to be voided and split-billed in order to be paid correctly. Any
questions should be directed to the Provider Relations unit at (800)
473-2783 or (225) 924-5040.
Pursuant to House
Concurrent Resolution 94 passed during the 2010 legislative session, the
Direct Service Worker Registry rule published in the Louisiana Register,
Vol. 32, No. 11, November 20, 2006 has been suspended temporarily. DHH
will not enforce compliance with these requirements during this time;
however, the Registry will continue to accept forms from providers that
want to register workers on a voluntary basis. For further information
on this legislation, please visit the DHH Health Standards website at
http://www.dhh.louisiana.gov/office/?ID=112. Link to DSW Registry
under "Featured Services."