RA Messages for September 13, 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 PROFESSIONAL SERVICE PROVIDERS
FEE SCHEDULE IN EXCEL FORMAT

The department is pleased to inform you that the Physician's Fee Schedule is now available in excel format. Providers are encouraged to visit the LA Medicaid website (www.lamedicaid.com) to view the fee schedule at your convenience. Please contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with any questions.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
PATHOLOGY CONSULTATIONS PERFORMED DURING SURGERY

A system issue has been identified, which was causing claims billed for the professional component of procedure codes 88333 (pathology consultation during surgery; cytologic examination, initial site) and 88334 (pathology consultation during surgery; cytologic examination, each additional site) to deny with error code 182 (procedure claim type conflict) when performed in the hospital setting. This system issue has been corrected and claims billed on or after August 12, 2011, should process appropriately. Claims that previously denied for this issue for dates of service October 1, 2009, through August 11, 2011, that were adjudicated prior to August 12, 2011, will be recycled on September 6, 2011, and no action is required from providers. Please contact the Molina Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning this issue.

 ATTENTION PROFESSIONAL SERVICES PROVIDERS
PROVIDING SERVICES PHASE IV LaCHIP (SCHIP) ELIGIBLES

It has been brought to the Department's attention that clarification is needed regarding the eligibility period of Phase IV LaChip recipients. This program provides prenatal care services, from conception to birth, for low income uninsured mothers who are not otherwise eligible for other Medicaid programs. This certification period begins with the first month of eligibility and continues without interruption until the pregnancy ends. There is no post partum eligibility period in this program.

Medicaid payments received by providers for inappropriate services are subject to review, recoupment and sanction.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
PROCEDURE CODES PAYABLE TO OPTOMETRISTS

Programming logic related to procedure codes payable to optometrists has been updated effective for dates January 1, 2010, forward. Claims that previously denied with errors 210, "PROVIDER NOT CERTIFIED FOR THIS PROCEDURE," 298, "INVALID PROCEDURE CODE FOR DATE OF SERVICE," and 299, "PROC/DRUG NOT COVERED BY MEDICAID," will be systematically adjusted and will appear on the RA of September 13, 2011. No action is required by providers.  

ATTENTION PROVIDERS THAT SUBMIT TPL/MEDICAID CLAIMS

We have learned that some TPL claims were processed recently without having the proper TPL payment information applied to the payment of the claims. The payments occurred on the 9/1/11 RA. This error has been corrected and the claims involved are being systematically adjusted to include the TPL payment on this RA (9/13/11). Please reconcile your accounts on these claims using the new payment appearing on this RA. We apologize for any inconvenience this may have caused.