RA Messages for
November 20, 2012
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.
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
Providers that submitted claims for services with a
diagnosis of behavioral health during the month of February 2012, after the
implementation of Bayou Health and before the implementation of the Louisiana
Behavioral Health Program (LBHP) received erroneous claim denials.
System edits were changed for the implementation of Bayou Health that
prevented these claims from being paid by Molina. The editing has been corrected
and the claims denied in error are recycled for payment by Molina on the RA of
11/06/12. We apologize for any
inconvenience this may have caused providers.
ATTENTION
AMBULATORY SURGERY
CENTER PROVIDERS
Medicaid pays Ambulatory Surgery Centers a facility
fee, and policy allows ASC providers to bill one procedure per recipient per
day, even when multiple procedures are performed. Through logic changes
and the implementation of Bayou Health, ASC providers began billing claims with
an attending provider included on the claim. This caused these
claims to process differently and by-pass the duplicate logic that denies
multiple procedures billed on the same date of service for the same recipient.
Thus, multiple procedures were paid to providers in some instances.
The inclusion of the attending provider number on ASC
claims also allowed these claims to process through ClaimCheck editing and cause
the denial of the claims submitted by the attending physician for his/her
services related to the surgical procedure.
New edit 077 (Attending Provider Must Be Billing
Provider) has been added to deny ASC claims that include an attending provider
number. When ASC claims are billed correctly without an attending provider
number, the system will deny claim lines for multiple procedures done on the
same day for the same recipient. It will also eliminate the ClaimCheck
editing issues between the ASC and physician claims.
Claims paid to ASCs that indicated an attending
provider number are being systematically voided on the RA of 11/13/12 and must
be resubmitted correctly for one procedure with no attending provider.
Physicians that received claim denials for their services related to ASC
procedures may resubmit these claims for processing. Questions may be
directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040.
ATTENTION PROVIDERS
Providers that submitted claims for services with a diagnosis of behavioral
health during the month of February 2012, after the implementation of Bayou
Health and before the implementation of the Louisiana Behavioral Health Program
(LBHP), received erroneous claim denials. System edits were changed for
the implementation of Bayou Health that prevented these claims from being paid
by Molina. The editing has been corrected and the claims denied in error
are recycled for payment by Molina on the RA of 11/06/12. We apologize for
any inconvenience this may have caused providers.