RA Messages for
December 1, 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
The deadline for being compliant with NCPDP D.0 is
fast approaching. Please be sure that any software changes needed for
interface with your telecommunications switch vendor are complete and
will be ready for use no later than January 01, 2010. If you have any
questions or concerns about readiness for submitting claims using the
new transaction, be sure and contact your software vendor and your
telecommunications switch vendor as soon as possible. These vendors
provider pharmacies with the ability to test electronic claims for
compliance with D.0 transaction standards. Visit lamedicaid.com for
additional information on NCPDP D.0 implementation using the 5010v of
the the HIPAA Electronic Transactions 11/7/11 link. Specifications for
Medicaid vendor point of sale (POS) adjudication, as well the
appendices, are available on the website.
ATTENTION PROFESSIONAL SERVICE PROVIDERS
Louisiana Medicaid has received multiple inquiries
related to the
denied reimbursement of claims specific to Pain Management. Louisiana
Medicaid Pain Management policy states:
"Epidurals administered for the prevention or control of acute pain,
such as that which occurs during delivery or surgery, are covered by
the Professional Services Program for this purpose only. Epidurals
given to alleviate chronic, intractable pain are not covered."
Therefore, epidurals or nerve block anesthesia administered to a
recipient following a surgical related procedure for the prevention
on management of postoperative pain will not be reimbursed.
CLARIFICATION OF OBSTETRICAL SERVICES AND
POSTPARTUM CARE POLICY
It has come to the attention of DHH that some
providers are continuing to submit claims for CPT code 59430 (Postpartum
care only [separate procedure]) when they have also submitted and been
paid for one of the delivery codes that include postpartum care. It has
been the intent of DHH that when the delivery codes that include
postpartum care were made payable, separate reimbursement for postpartum
care was no longer valid if those inclusive codes were used. Providers
who perform both the OB delivery services and the postpartum care should
use the code that describes these services and not unbundle the services
by use of individual procedure codes. As with all claim submissions,
providers are to use the most inclusive code available. Only when there
is not a more appropriate code available should providers use the
separate code for the postpartum service. At no time does Louisiana
Medicaid intend to reimburse more than once for postpartum care.
Providers should refer to the Current Procedural Terminology manual for
additional coding guidance related to these services. Providers are
urged to review their billing practices and take action as needed to be
in compliance with Medicaid policy. Overpayments and abusive billing are
subject to recoupment and/or sanction.
FAMILY PLANNING WAIVER "TAKE CHARGE"
Procedure codes 76830 - Echography Transvaginal,
76856 - Echography Pelvic, Real Time, and 85025 - Blood Count; Plat.
Count Auto/Amt. are not currently covered by the Louisiana Medicaid Take
Charge family planning waiver program. Providers are responsible for
knowing if a service is not covered and should inform the recipient
prior to rendering the service.
ATTENTION PROFESSIONAL SERVICES PROVIDERS
CONCURRENT CARE CLAIMS RECEIVING DUPLICATE EDITS
Due to a system error some claims for inpatient
Concurrent Care were erroneously denied as duplicate claims. The logic
that allowed the posting of this edit in error has been corrected and
all claims impacted by this edit problem have been identified and will
by systematically adjusted on 12/1/11. Some of the recycled claims will
pend or deny for other, correct edits. Providers must review and
resubmit any denied claims that can be corrected and resubmitted for
processing. Please contact Provider Relations at (800) 473-2783 or (225)
924-5040 with questions concerning this issue.