RA Messages for September 03, 2013
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
Starting July 18, 2013, a notice was posted on Molina's web site and in RA messages from Molina informing providers that
effective 8/6/2013 (date of payment), Medicare crossover claims for Behavioral Health services would be denied with new
edit 133 and the claims would automatically be sent to Magellan for processing. We are notifying you that there is a delay
in the automatic transfer, but that it will occur, just at a point toward the end of this month or early in September.
Providers will continue to see these denials (edit 133) in Molina's processing system, and all of these claims
(with payment date 8/6/2013 and after) will be transmitted to Magellan. No action is required on the part of the
provider. We apologize for any inconvenience this may cause.
Attention Pharmacists and Prescribing Providers:
Effective September 1, 2013 Louisiana Medicaid will reimburse enrolled pharmacies for the 2013-2014 influenza
vaccines and administration of the vaccines for recipients who are nineteen years and older when the
administering pharmacist is an enrolled Medicaid provider. The cost of the vaccine will not be reimbursed for
recipients under the age of nineteen as these vaccines are available through the Louisiana Vaccines for
Children (VFC) program. Only the administration fee will be reimbursed for these recipients. See
ATTENTION PROVIDERS: PAYMENT ERROR RATE MEASUREMENT (PERM) TO BEGIN 10/01/2013
LA Medicaid is mandated to participate in the Centers for Medicare and Medicaid (CMS) Payment Error
Rate Measurement (PERM) program which will assess our payment accuracy rate for the Medicaid and LACHIP
programs. The results of these reviews will be used to produce a national error rate which will be reported
to Congress. If chosen in a random sample, your organization will soon receive a Medical Records
Request from the review contractor, A+ Government Solutions. A period of 75 days from the date of receipt
of the request will be given to submit the requested documentation. If no documentation or incomplete
documentation is submitted, the claim(s) will be considered to be an error and is subject to a payment
recovery through withholding of payment, and/or a possible fine. REMINDER: Providers who are no longer
doing business with Louisiana Medicaid are obligated to retain recipient records for 5 years,
under the terms of the Provider Enrollment Agreement.
FOR MORE PERM INFORMATION: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/Providers.html.
Attention Electronic Billers/Submitters of Institutional Claims
We want to remind providers and submitters that the following Bill Type codes are the only codes that are
acceptable for the Louisiana Medicaid Program, including Bayou Health claims and encounters. The file extension
of the electronic claim file is also very important in combination with the Bill Type codes.
For file extension 837I � UB9 the acceptable Bill Type codes are: 11X, 12X, 13X, 14X, 18X, 71X, 72X, 76X, 81X,
82X, 83X, 85X, 86X; 89X
For file extension 837I � HOM (Home Health) the only acceptable Bill Type code is 33x. When billing Home Health
claims electronically you must use the file extension 837I � HOM.
For file extension 837I � LTC (Long Term Care) the only acceptable Bill Type codes are: 21X, 65X, 66X.
These codes are ONLY acceptable for Long Term Care billing. Hospitals may not use these codes.
Electronic 837I billing files that are submitted with Bill Type codes not included in those listed above will
be rejected and not entered into the claims processing system. One of the most common errors identified for
file rejections is the use of Bill Type 33x with file extension 837I- UB9.
Providers must review the billing instructions for their provider type to ensure use of acceptable Bill Types
for their program. Providers using a Bill Type from the list above that is not acceptable for the specific
provider type/medical program will receive a denial of 042 � Invalid UB Bill Type.