RA Messages for
December 27, 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 HOSPITAL, PHYSICIAN AND OUTPATIENT
EFFECTIVE JANUARY 1, 2012, FOR THE RADIOLOGY UTILIZATION MANAGEMENT
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
ATTENTION ALL PROVIDERS SUBMITTING OR
5010 CLAIM TRANSACTIONS (820, 835, 837D, 837I, and 837P)
In order to allow additional time for providers to test, Molina will
continue to accept Version 4010 electronic claims transactions after
January 1, 2012. CMS has announced that they will not initiate
enforcement action with respect to any HIPAA covered entity that is not
in compliance with the implementation date for the ASC X12 VERSION
5010 STANDARDS until March 31, 2012.
In preparation for 5010 implementation, providers should continue to
work with their billing entities to ensure that they will be ready for
submittal prior to March 31, 2012.
For more detailed information, the revised 5010 EDI Companion Guides
are published on the Louisiana Medicaid Website, under the 5010 link
on the main page.
Access the website on a regular basis for 5010 implementation updates
ORGANIZATIONAL VS INDIVIDUAL NPI IN 5010
With the transition to 5010 specifications, when submitting the 837
claim transactions, an individual billing provider that is incorporated
must enter the organizational NPI as the Billing Provider identification
number and the individual NPI as the Rendering Provider identification
number. Individual billing providers that are incorporated and have not
previously obtained both an organization (business entity) NPI and an
individual NPI should apply for an organization NPI as well as an
individual NPI at this time. Both NPIs must be reported to the Molina
Provider Enrollment Department. Claim denials may result if this
information is not reported to us and properly entered in the
transactions. This clarification has been added into the 5010
837 Professional Companion Guide.
NOTE: THIS CHANGE DOES NOT APPLY IF THE INDIVIDUAL IS UNINCORPORATED.
ATTENTION GREATER NEW ORLEANS COMMUNITY
HEALTH CONNECTION (GNOCHC)
PROVIDERS: EDIT 904 AND CLAIMS DENIAL
Due to a system error, some claims that received edit 904 (Service
Performed Beyond the Required Time Specification) were not denied but
posted the edit and continued to process for payment. This edit is
posted for any claim that was received after the deadline of November
14, 2011, for Dates of Service prior to October 1, 2011. Those claims
that have been paid that should have denied for the edit 904 are being
systematically voided on 12/13/11. We apologize for the inconvenience
this may have caused providers.
IMPORTANT UPDATE CONCERNING CHANGES TO
THE ELECTRONIC CLAIMS STATUS INQUIRY (eCSI) APPLICATION
LA Medicaid's Claim Status Inquiry (eCSI) application
has been modified support both 4010 and 5010 transactions. This will
enable providers to choose which version of the application they want to
use. The modified version will be available for use on Saturday,
December 17, 2011. Once providers log into the LA Medicaid website,
www.lamedicaid.com, select the Claim Status Inquiry application from the
menu of web applications available. The 4010 version of the eCSI web
application will appear. A new link has been added to this web page
which allows a provider to navigate to the 5010 version of eCSI. To
select use of the 5010 version, click the button located at the top
center of the screen titled "Click Here for the ASCX12 5010 version of
the eCSI application." Click the Help button at the top of the web page
to view the User Guide.
On Saturday, December 17, 2011, this web application will be unavailable
for approximately 2 hours between 6 a.m. and 8 a.m. while the change is
being implemented. This dual version will be available for several weeks
prior to the obsolete 4010 version being removed. Providers will be
notified of when the 4010 version will no longer be available for use.
IMPORTANT UPDATE ON NCPDP D.0 AND 5010
IMPLEMENTATION EFFECTIVE JANUARY 1, 2012
A reminder that effective January 1, 2012, all
electronic billings from Louisiana Medicaid pharmacy providers must be
conducted using the HIPAA NCPDP D.0 version of the transaction
standards. Pharmacy Point of Sale claims that are submitted in the NCPDP
5.1 format will be denied if received after 12/31/11 at 11:40 PM.
The Point of Sale system will be down from approximately 11:45 PM CST on
12/31/11 until 7:00 AM CST on 1/1/12 for the system changes to be
implemented. We will bring the system up earlier if the implementation
and monitoring of the changes require less time.
The MEVS (eligibility verification system) will be down for
approximately 30 minutes beginning at 11:45 PM CST on 12/31/11.
Recipient eligibility can be verified using MEVS, eMEVS, or REVS
beginning approximately 12:15 AM on 1/1/12.