RA Messages for September 7, 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.
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."
Effective for dates of service
on and after August 1, 2010, the dental procedure code for Prefabricated
Esthetic Coated Stainless Steel Crown-Primary Tooth (D2934) is reimbursable by
Medicaid in the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Dental
Program. Complete details can be located on the www.lamedicaid.com website under
the 'Dental Providers' and 'Fee Schedules' links. Contact the LSU Dental
Medicaid Unit at 504-941-8206 or 866-263-6534 (toll-free) with any questions.
CLAIMCHECK MULTIPLE SURGERY/MODIFIER-51 PROCESSING
Beginning with the September
7, 2010 date of processing, ClaimCheck editing related to multiple surgical
procedures during the same surgical session performed by the same provider has
been updated. This update was necessary to prevent inadvertent duplicate denials
and to properly apply the multiple surgery reductions based on industry
standards including the relative value units for the procedures. In addition,
this revision will now expedite correct payment and prevent additional
administrative burden for providers by minimizing the need to resubmit claims
where the -51 modifier was incorrectly applied. With this update, when the -51
modifier has or has not been applied to the appropriate procedure(s), the system
will now add or remove the -51 modifier from the claim and will then process and
reimburse the claim accordingly. The denial codes previously used (errors 934
and 938) will now reflect an educational message (EOB) indicating whether the
-51 modifier was added or removed from the procedure code for processing.
Providers will see the following EOB messages when these edits occur:
934: Modifier 51 required. Added to claim-ClaimCheck.
938: Modifier 51 invalid. Removed from claim-ClaimCheck.
When all procedures of the same surgical session have adjudicated,
overpayments identified by providers are to be handled via the current
adjustment/void process. As part of the on-going assessment and
adjustments in claims processing related to the implementation of
ClaimCheck editing, Louisiana Medicaid anticipates minimizing
current hard copy requirements related to surgical procedures wherever
possible. Providers will be notified as these improvements occur.
Providers should note that claims adjudicated prior to ClaimCheck
implementation were subject to reimbursement policy and practices on
the date of adjudication.
The recycle of claims that have been previously denied for errors 934
and 938 since the implementation of ClaimCheck editing is anticipated
to occur on the R/A of September 14, 2010. For further questions,
please contact Molina Provider Relations at 225-924-5040 or