RA Messages for October 19, 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
PROVIDERS OF INFLUENZA VACCINE
The 2010-2011 seasonal
influenza vaccine includes as one of its three components the same H1N1
vaccine used for the 2009-2010 H1N1 pandemic. Also, as of 09/16/2010,
the only remaining available 2009-2010 monovalent H1N1 vaccine inventory
in circulation reached its expiration and should no longer be used.
Therefore, effective 09/16/2010, procedure code 90663 (influenza virus
vaccine, pandemic formulation) will be in non-payable status and claims
submitted with dates of service 09/16/2010 and after will deny.
Providers submitting claims for the 2010-2011 seasonal influenza vaccine
should use the appropriate CPT procedure code for the vaccine
formulation administered following current immunization billing policy.
Detailed information on the 2010-2011 seasonal influenza vaccine can be
found at www.cdc.gov/flu. Contact
Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225)
924-5040 if you should have any questions.
Effective with DOS
October 1, 2010, the 2010 ICD-9 diagnosis codes and operation codes have
been added to our files. The files have also been updated to deny those
codes now considered invalid. Providers should use the most complete and
appropriate diagnosis and operation codes when submitting claims to
MENTAL HEALTH CLINIC (MHC) PROVIDERS
As of 09/16/2010, the
only remaining available 2009-2010 monovalent H1N1 vaccine inventory in
circulation reached its expiration and should no longer be used.
Effective 09/29/2010, procedure code 90663 (Influenza virus vaccine,
pandemic formulation) will be in non-payable status and claims submitted
with dates of service 09/16/2010 and after will deny. Contact Molina
Medicaid Solutions Provider Relations at (800) 473-2783 or (225)
924-5040 if you should have any questions.
DME PROVIDERS - INCLUDING PHARMACIES
PROVIDING DME SERVICES
Effective November 5,
2010, Louisiana Medicaid will require DME providers to submit National
Drug Code (NDC) information on prior authorization requests and claims
submissions for enteral therapy products dispensed to Medicaid
recipients. This requirement applies to all DME providers, including
pharmacies that dispense the DME supplies to Medicaid recipients. NDC
information must be submitted on PA requests received on November 5,
2010 forward and associated claims in order to prevent denial of
services. Please visit the LA Medicaid website homepage at
www.lamedicaid.com for details, including the list of products and
associated NDC data and other important information.
PROFESSIONAL SERVICES PROVIDERS
UPDATE REGARDING CLAIM ADJUSTMENTS ON THE 9/22/10 & 10/16/10 RAs
The remaining claim
adjustments for the Aug 4, 2009 and Jan 22, 2010 rate reductions were
completed on either the RA of Sept 22, 2010 or Oct 6, 2010. Refer to the
notices on the homepage of the Louisiana Medicaid website (www.lamedicaid.com)
for details regarding the rate reductions and claim adjustments.
Providers affected by the Oct 5, 2010 RA payment/recovery error were
repaid the amount recovered in error beginning on Mon, Oct 11, 2010. In
an effort to ensure that no further errors occur for providers having
funds recovered through their weekly RAs, DHH will not be deducting
funds from the RA of October 19 and potentially not from the RA of Oct
26, 2010. This action is being taken in an effort to ensure adequate
testing of the system is completed prior to re-establishing these
payment plans. Continue to monitor RAs and the LA Medicaid website. The
Department will, however, recover funds for any provider that has
requested that their full negative balance be recovered in one RA
beginning on the October 19, 2010 RA.
Any provider still interested in an alternative payment plan is STRONGLY
ENCOURAGED to send an email by OCTOBER 26, 2010 to
email@example.com detailing your request. Please
enter "Alternative Payment Plan" in the subject line. This request is
being made to help minimize any future errors due to the sporadic influx
of requests the Department is receiving.
RECYCLE OF MODIFIER -51 DENIALS
The recycle of claims
that have been previously denied for errors related to modifier -51 (934
and 938) is scheduled to appear on the remittance advice of October 19,
2010. 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. The small number of
claims that must pend for either medical review and/or issues such as
timely filing will be handled outside of this recycle. Please continue
to monitor the Louisiana Medicaid website homepage at www.lamedicaid.com,
under the ClaimCheck icon on the website, as well as future RA messages
for the latest information. For further questions related to this
matter, contact Molina Provider Relations at (800) 473-2783 or (225)