RA Messages for September 14, 2010


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


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.


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.


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.


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.


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 800-473-2783.


The recycle of claims that have been previously denied for errors (934 and 938) related to modifier -51 will not appear on the R/A of September 14, 2010, as anticipated in a previous message. (The recycle will apply only to those claims denied with these errors prior to the update related to modifier -51 that was effective with the date of processing of September 7, 2010.) Testing of the recycle is underway as a priority and is expected to be finalized within the next few weeks. Providers will be notified when the testing is complete and provided with pertinent details about the recycle. Please continue to monitor the Louisiana Medicaid website homepage at www.lamedicaid.com, under the ClaimCheck icon on the website, as well as RA messages for the latest information. For further questions related to this matter, contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.