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 http://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.

New Louisiana Department of Health and Hospitals Adverse Actions Web Search:

As a condition of participation in the Louisiana Medicaid Program, providers are responsible for ensuring current and potential employees, contractors and other agents and affiliates have not been excluded from participation in the Medicaid, or Medicare Program by Louisiana Medicaid, or the Department of Health and Human Services' Office of Inspector General. Providers who employ or contract with excluded individuals or entities may be subject to penalties of $10,000 for each item or services the excluded individual or entity furnished.

Providers have been previously instructed to check the websites of the Department of Health and Human Services' Office of Inspector General at http://exclusions.oig.hhs.gov and the System for Award Management (SAM) website at https://sam.gov/portal/SAM#1 for any exclusion imposed at the federal level upon hire and monthly thereafter for employees and/or subcontractors that perform services that are compensated with Medicaid/Medicare funds. Please be reminded that the SAM site is only for entities, and providers do not need to check employees on the SAM site.

Effective immediately, providers should check the Louisiana Department of Health and Hospitals Adverse Actions website at https://adverseactions.dhh.la.gov upon hire and monthly thereafter for individuals and entities that have had adverse actions imposed. This is a user friendly site that allows single and multiple searches of individuals and entities. The user may also choose to export the database and have it available in an Excel spreadsheet. Providers are required to maintain proof in their records that checks were done for employees and/or subcontractors. This may be done by printing out the result of the search.

All current and previous names used such as first, middle, maiden, married or hyphenated names and aliases for all owners, employees and contractors should be checked. If an individual's or entity's name appears on these websites, this person or entity is considered excluded and is barred from working with Medicare and/or the Louisiana Medicaid Program in any capacity. If the exclusion is learned prior to employment the provider should not employ the person or entity. If the provider learns of the exclusion after hiring the provider must notify the Department of Health and Hospitals within ten working days of discovering the exclusion with the following information:

  • Name of the excluded individual or entity and
  • Status of the individual or entity (applicant or employee/contractor).

If the individual or entity is an employee or contractor, the provider should also include the following information:

  • Beginning and ending dates of the individual's or entity's employment or contract with the agency,
  • Documentation of termination of employment or contract, and
  • Type of service(s) provided by the excluded individual or entity.

These findings should be reported to:

DHH.Medicaid.State.Exclusion@la.gov or

Department of Health and Hospitals
Program Integrity
P.O. Box 91030
Baton Rouge, LA 70821-9030

This new adverse actions web search tool does not replace the Nurse Aide Registry/Direct Service Worker Registry found at www.labenfa.com. Providers that employee Certified Nursing Assistants (CNA) and Direct Service Workers (DSW) are still required to check these registries upon hire and every six months thereafter.

These requirements are identified in the Provider Enrollment Agreements, the Medical Assistance Program Integrity Law (MAPIL) cited as Louisiana Revised Statute 46:437, referenced in the Louisiana Administrative Code (LAC) Title 50 and the Code of Federal Regulations 42 CFR § 455.436.

All excluded individuals must request reinstatement after the minimum excluded period has been served. There is no automatic reinstatement at either the federal or state level.

ATTENTION PROVIDERS REMINDER

On August 11, 2014, Molina systemically voided all identified paid claims for legacy and shared plan recipients associated with the retroactive enrollment or dis-enrollment of Bayou Health members and plan linkages from February 1, 2012 through June 30, 2014. These voids appeared on RAs with edit 999, Administrative Correction.

A Remittance Advice message ran from July 29, 2014 through August 12, 2014 and a web notice was posted on August 8, 2014 notifying providers that DHH would void all paid claims.

The 6 month deadline to resubmit these voided claims is February 11, 2015. 

We are reminding providers that this deadline is approaching.

All claims and required documentation must be resubmitted to the correct entity by that date in order to be considered for payment. 

Providers should refer to the web notice (08/06/14) or RA messages mentioned above for detailed directions on how to resubmit these claims.

If you have any additional questions or concerns, please contact Darlene White at (225)342-5924 or Darlene.White@la.gov

ATTENTION ALL PROVIDERS
CHANGES IN POST OFFICE BOXES FOR SUBMISSION OF PAPER CLAIMS
EFFECTIVE FEBRUARY 1, 2015

Effective February 1, 2015, Molina will be consolidating several Post Office boxes and providers should begin sending claims to the newly assigned box.

Below is a list of the Post Office boxes currently used (indicated as Old Box Number) and a list of the corresponding 'New' box assigned for that claim type (indicated as New Box Number).

Please share this information with your staff and make the necessary changes in your internal procedures to begin sending your paper claims to the new box immediately.

Old Box Number New Box Number

91019

(Pharmacy)

 91020

91021

(Hospital/Hemodialysis/Hospice/LTC)

 91020

91022

(Dental/Home Health/Rehab/Transportation)

 91020

91023

(All Medicare Crossovers)

 91020

14849

(KIDMED)

 Program ended 2012; claims may no longer be submitted.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040. Thank you for your assistance in this matter.

REMINDER: ACA Primary Care Services Enhanced Rates End December 31, 2014

The Affordable Care Act requires State Medicaid programs to pay enhanced rates for certain primary care services provided during calendar years 2013 and 2014.

For claims filed timely, the enhanced rates will continue to be paid for dates of service during calendar years 2013 and 2014.

For services provided on or after January 1, 2015, the enhanced rates will no longer apply and the regular Medicaid rates will be paid.

More information on the ACA Enhanced Reimbursement can be found online at http://www.lamedicaid.com/provweb1/ACA/ACA.htm.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective January 1, 2015, the dispensing fee portion of pharmacy reimbursement methodology for Louisiana Medicaid Fee for Service (FFS) Pharmacy Program will increase to $10.51. Please refer to www.lamedicaid.com for specifics.

ATTENTION GNOCHC PROVIDERS

For Demonstration Year 4 covering time period, 10/1/2013 - 9/30/2014, providers must have submitted claims for processing no later than 11/14/2014. Claims submitted after this date have been identified and will be voided in the 12/30/2014 check write.

ATTENTION ALL PROVIDERS

DHH has identified paid claims associated with administration corrections of member's linkages into Bayou Health Plans. These linkage corrections were necessary to ensure compliance with internal policies, approved Medicaid State Plan and maintaining audit controls. Member linkages from July 1, 2014 through October 31, 2014 were evaluated and claims paid by an incorrect entity (CHS, UHC or Molina) have been identified. On December 30, 2014, Molina will systemically void all identified paid claims with a denial reason code 999 Administrative Correction, which will be shown on the Remittance Advice.

In order to rebill, providers must verify the correct entity based on the date of service by using either MEVS or REVS. To obtain consideration for payment, providers are required to submit hard copy claims to the correct entity no later than 6 months from the date the claim is voided. Legacy Medicaid Claims must be sent through Molina's Provider Relations Department. If PA or Pre-Cert was obtained on the original claim, providers will not be required to obtain additional authorization when submitting these specific prior-paid claims to the correct entity. Documentation must accompany claims verifying the prior payment and void. This documentation of prior payment will also support the authorization of the service. Claims submitted within 6 months of the void date will not be denied based on timely filing.

For this clean-up only, the Making Medicaid Better website ( www.makingmedicaidbetter.com) contains a list of affected providers which includes the provider name, a partial Medicaid Provider ID (to protect privacy), the number of claims, number of recipients, and total of payments to be voided. Questions may be sent to Bayou Health at bayouhealth@la.gov, with the subject lined addressed to "Retro Claims".

Beginning January 2015, the process of voiding identified paid claims will be repeated on a monthly basis to occur around mid-month, for administrative corrections made to member linkages in the prior month.

If you have any additional questions or concerns, please contact Darlene White at (225) 342-9076 or Darlene.White@la.gov.

Policy Update:
Billing Add-on Codes for Maternity-Related Anesthesia
(01967/01968, 01969)

Effective with date of processing November 25, 2014, typical add-on code processing rules were updated for obstetric anesthesia procedures codes 01967 and add-on codes 01968 and 01969. Add-on codes are not considered a full service, and in most cases, cannot be reimbursed without the primary procedure being billed and paid to the same attending provider. The exception to this is when more than one provider performs services over the duration of labor and delivery.

When an add-on code is used to fully define a maternity-related anesthesia service, the date of delivery should be the date of service for both the primary and the add-on procedure. This would apply regardless of whether the same or different providers bill for each service. For questions related to this information as it pertains to legacy Medicaid or Bayou Health Shared Savings Plans claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention DME Providers
National Correct Coding Initiative (NCCI) Procedure to Procedure Edits
To Be Implemented for DME Providers

The Affordable Care Act requires that States incorporate NCCI edits and methodologies for Medicaid claims processing. These edits are being implemented for DME services in the coming months. DME NCCI code pairs can be found on the CMS Medicaid website, http://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/national-correct-coding-initiative.html.

Procedure to procedure edits are defined as pairs of HCPCS/CPT codes that should not be reported together. These NCCI edits are applied to services performed by the same provider for the same recipient on the same date of service. When appropriate, modifiers may be applied to further describe the clinical scenario. Louisiana Medicaid's claims processing system is updated to accept all NCCI-associated modifiers.

Providers may NOT bill recipients for services denied by NCCI edits.

Providers could expect to see denials on procedures that may have previously paid when billed in the same manner. For NCCI edits, the decision on which procedure code of a code pair is payable is determined by CMS. CMS updates these edits quarterly. DME providers may see new edit messages that pertain specifically to the NCCI edits. Currently these are:

  • 731-'CCI: Procedure incidental to another current procedure.'

  • 759-'CCI: Procedure incidental to a procedure in history.'

  • 982-'CCI: History procedure incidental to current-history voided.'

Each Bayou Health prepaid plan is required to implement NCCI editing, but may have slightly different implementation schedules and billing policy related to the mandate. Please contact each prepaid health plan for information specific to that plan.

Please continue to refer to notices on www.lamedicaid.com for additional information as this transition occurs. Providers are also encouraged to access information related to NCCI editing on the CMS website, www.cms.gov, under the Medicaid link by entering 'NCCI' in the search box.

For questions related to this information as it pertains to legacy Medicaid or Bayou Health Shared Savings plans' claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.