RA Messages for
November 3, 2011
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
ATTENTION PHARMACY PROVIDERS
New this influenza season is the Fluzone�
intradermal vaccine, which is indicated for ages eighteen to sixty-four.
This vaccine is not provided by the Louisiana Vaccines for Children
(VFC) program this season. Therefore, Medicaid will reimburse pharmacy
providers the cost of the vaccine and its administration when given to
recipients who are ages eighteen through sixty-four.
Reimbursement by Medicaid of this influenza vaccine and
administration is limited to the following fees:
||Maximum Vaccine Reimbursement
||Maximum Administration Fee Reimbursement
|Influenza Vaccine, Intradermal
Please click the link for Pharmacy & Prescribing Providers
link, and then the Influenza link, and see the 2011-2012 Influenza Season
section for detailed policy, reimbursement, and billing information.
Effective November 1, 2011,
Louisiana Medicaid will stop printing and mailing standard paper
remittance advices to providers, billing agents, or other entities
representing providers. Weekly standard paper remittance advices (RAs)
will be posted on the secure side of the Louisiana Medicaid website,
www.lamedicaid.com. A new link, Weekly Remittance Advices, will be
available for accessing these documents in PDF format. Providers that
are not registered on our website must register in order to access the
secure side. Once registered, providers may grant logon access to
appropriate staff and/or any entity representing them. Individuals
allowed to access these RAs will have the ability to download and save
or print the documents for reconciling accounts.
A one (1) month grace period will occur from October 1, 2011,
November 1, 2011, during which RAs will be mailed and posted to the
website. This will allow providers ample time to implement procedures
for appropriate individuals to access this information online. Effective
November 1, 2011, standard RAs will be available only online through the
website. Please visit our website for additional information.
NOTE: This transition does not impact the HIPAA 835 electronic RA
procedures or process.
ATTENTION PROFESSIONAL SERVICES PROVIDERS
RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENTS
Louisiana Medicaid has recently made the following radiopharmaceutical
diagnostic imaging agents payable on the procedure code file effective
January 1, 2010:
- A9503 (Technetium Tc-99m, Medronate, diagnostic, per study dose, up
to 30 millicuries)
- A9507 (Indium IN-111 Capromab Pendetide, diagnostic,per study dose,
up to 10 millicuries)
- A9512 (Technetium Tc-99m-Pertechnetate, diagnostic, per millicurie)
- A9560 (Technetium Tc-99m Labeled Red Blood Cells, diagnostic, per
study dose, up to 30 millicuries)
- A9562 (Technetium Tc-99m Mertiatide, diagnostic, per study dose,
up to 15 millicuries)
- A9572 (Indium IN-111 Pentetreotide, diagnostic, per study dose,
up to 6 millicuries)
The system has been updated to reflect this change. Claims
imaging agents with dates of service January 1, 2010, through April 6,
2011, that were adjudicated prior to April 7, 2011, were systematically
adjusted on October 12, 2011.
Effective with date of processing August 16, 2011, claims for
radiopharmaceutical diagnostic imaging agents will only be reimbursed
when billed with the appropriate medically necessary radiological
procedure. The imaging agent is not to be paid unless the appropriate
radiological procedure is also paid on the same date of service.
Providers are encouraged to contact the Provider Relations unit at
(800) 473-2783 or (225) 924-5040 with questions concerning this issue.
ATTENTION PROFESSIONAL SERVICES PROVIDERS
INFLUENZA IMMUNIZATIONS FOR ADULTS - NEW VACCINE AVAILABLE
A new influenza virus vaccine for intradermal use will be available for
the 2011-2012 influenza season. This vaccine is currently licensed and
indicated for use in patients 18 years through 64 years of age.
Louisiana Medicaid has added this new vaccine as a covered service for
recipients 18 through 64 years of age only. This intradermal influenza
vaccine will be in addition to the currently covered influenza,
pneumococcal and human papillomavirus vaccines. At this time, this
vaccine will not be available from the Louisiana Vaccines for Children
Professional Services providers may be reimbursed for
vaccines and the administration of the vaccines for adult recipients. As
the new intradermal vaccine will not be available from the VFC program
for the 2011-2012 season, Louisiana Medicaid will reimburse providers
for the new intradermal influenza vaccine as well as for the
administration of the vaccine for recipients aged 18 through 64 years.
If at a later date this vaccine does get included in the VFC program,
Louisiana Medicaid will no longer reimburse providers for the vaccine
for recipients 18 years of age but only for the administration of the
For detailed information, see www.lamedicaid.com, following the link for
Billing Information/Immunizations/Adult Immunization Policy. For the
current Immunization Fee Schedule, follow the link for Fee
Schedules/Immunization Fee Schedules and choose the Immunization
Fee Schedule appropriate for the recipient's age.
Contact Molina Medicaid Solutions Provider Relations at (800)
or (225) 924-5040 if you should have any questions.
ATTENTION PROFESSIONAL SERVICE PROVIDERS
The Department is pleased to inform providers, effective November 1,
2011, the list of diagnosis codes reimbursable for Hyperbaric Oxygen
Therapy has been updated. The diagnosis codes for the following
conditions will now be reimbursable as follows:
Acute carbon monoxide intoxication,
Acute peripheral arterial insufficiency,
Acute traumatic peripheral ischemia,
Chronic refractory osteomyelitis unresponsive to conventional
Crush injuries and suturing of severed limbs,
Diabetic wounds of the lower extremities,
Osteoradionecrosis as an adjunct to conventional treatment,
Preparation and preservation of compromised skin grafts,
Progressive necrotizing infections,
Soft tissue radionecrosis as an adjunct to conventional treatment.
Providers should contact the Provider Relations unit at (800) 473-2783
or (225) 924-5040 with billing or policy questions.