RA Messages for November 3, 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 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:  

Vaccine Maximum Vaccine Reimbursement Maximum Administration Fee Reimbursement
Influenza Vaccine, Intradermal $18.38 $15.22

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.

ATTENTION PROVIDERS

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, to 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 for these 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 (VFC) program.

Professional Services providers may be reimbursed for seasonal influenza 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 vaccine.

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) 473-2783 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
treatment,
Crush injuries and suturing of severed limbs,
Decompression illness,
Diabetic wounds of the lower extremities,
Gas embolism,
Gas gangrene,
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.