RA Messages for September 24, 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: 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.
Update to �ClaimCheck� Product Editing
Effective with the Remittance Advice of September 3, 2013:
McKesson�s �ClaimCheck� product is routinely updated by the McKesson Corporation based on changes made to the
resources used, such as Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding
System (HCPCS) coding guidelines, the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule
Database, and/or provider specialty society updates. The �ClaimCheck� product�s procedure code edits are guided
by these widely accepted industry standards. The edit changes will affect claims processed beginning with the
remittance advice of September 3, 2013. Providers may notice some differences in claims editing as most claims
will continue to edit in the same manner but when applicable, claims may now pay or deny for a different reason.
Providers will continue to be notified when routine updates are made in the future.
For questions related to this information, please contact Molina Medicaid Solutions Provider Services at
(800) 473-2783 or (225) 924-5040.
Attention all Providers-- Check Write Date Change:
The check write that was previously scheduled for Tuesday, October 1, 2013 has been rescheduled and will be dated Monday,
September 30, 2013. Please be sure and advise your submitters, business partners, etc. of this change. The EFT date for
these payments will be Tuesday, October 1, 2013.