RA Messages for December 6, 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

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.

UPDATE AND 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when the delivery codes that include postpartum care were made payable, separate reimbursement for postpartum care was no longer valid if those inclusive codes were used.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" PROVIDERS

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 HOSPITAL, PHYSICIAN AND OUTPATIENT RADIOLOGY PROVIDERS
EFFECTIVE JANUARY 1, 2012, FOR THE RADIOLOGY UTILIZATION MANAGEMENT PROGRAM (RUM)

One new CPT code has been established for Computed Tomographic Angiography (CTA) study of the abdomen and pelvis. The code is 74174. This code becomes effective January 1, 2012, and is included in the Radiology Utilization Management (RUM) program. This code will require prior authorization (PA). The code description is listed below:

- 74174 Computed tomographic angiography; abdomen and pelvis; with contrast material(s), including noncontrast images, if performed, and image postprocessing

If prior authorization (PA) is not obtained for this procedure per the current RUM guidelines, then the procedure will not be payable by Louisiana Medicaid. For further information regarding RUM policy and procedure please visit www.lamedicaid.com.

ATTENTION PROFESSIONAL SERVICE PROVIDERS

Effective December 1, 2011, Louisiana Medicaid will provider coverage for fluoride varnish. For coverage details and policy information please refer to www.lamedicaid.com. Providers should contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with billing or policy questions.