RA Messages for January 06, 2009

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.  

Detailed FUL changes are posted on www.lamedicaid.com. 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. 

IMMUNIZATION PAY-FOR-PERFORMANCE INITIATIVE

A slide presentation with detailed information on Louisiana Medicaid's CommunityCARE Immunization Pay-for-Performance Initiative has been placed on the LA Medicaid website (www.lamedicaid.com) following the link for Pay-for-Performance in the directory on the home page. Providers that administer immunizations to Medicaid enrolled children are encouraged to review this material online.

ATTENTION: PROVIDERS ADMINISTERING IMMUNIZATIONS

LA Medicaid has placed three vaccine CPT procedure codes in non-payable status for Medicaid recipients. These vaccines are no longer available from VFC as they are no longer acceptable for use in the United States. The two components affected are DTP, which has been replaced with DTaP, and OPV, as oral polio vaccine is no longer used in the US. The non-payable codes are: 90701, 90712, and 90720. Please review the online Immunization Fee Schedule at www.lamedicaid.com for acceptable vaccine codes and ensure that you are using the correct procedure code for the vaccine administered.

ATTENTION HOSPITAL PROVIDERS

We continue to receive questions from providers concerning the 2007 policy clarification related to billing ONLY ONE revenue code 450 for out-patient emergency room visits and the recent RA message related to this subject indicating that denial edits are now in place to prevent billing multiple 450-459 revenue codes in these circumstances. We understand that Medicare and other payers allow billing multiple 450-459 codes in certain circumstances, however, this is NOT LA Medicaid policy.

The appropriate level of ER visit code should be billed on your outpatient claim form, and the services performed MAY NOT be billed separately under other 450-459 codes or any other revenue codes. The appropriate HCPC designating the applicable level of ER visit (99281-99285) is the only allowed HCPC.

Claims should include all other appropriate revenue codes (i.e. pharmacy, lab, x-rays and supplies) which were utilized in the patient's treatment, using the appropriate revenue code and procedure code/HCPC if applicable.

Hospitals should establish a charge/fee for EACH level of emergency room visit (99281-99285). That charge/fee is all-inclusive for whatever services are being performed in the emergency room/department (i.e. use of room, injections, infusions, suturing, casting, etc.) Any non-ambulatory surgical (HR490) services performed in the ER such as the application of splints, injections, suturing, etc. are built into the reimbursement paid to the hospital under one of the 5 ER visit codes depending on the level of complexity of the ER visit.

ATTENTION ALL PROVIDERS
2009 HCPCS UPDATE

Louisiana Medicaid is in the process of completing the programming for the 2009 HCPCS updates. This includes both new and deleted codes for 2009. Every attempt is being made to have the new codes/updates on file by mid January 2009. Please note that all appropriate editing and coverage determinations for the new codes may not be final at that time and adjustments to claims processed may be necessary. Providers should monitor future RA messages.

ALL PROVIDERS

The Louisiana Legislature has funded additional New Opportunity Waiver slots through the NOW Trust Fund. Most New Opportunity Waiver slots filled on or after November 3, 2008 are part of the NOW Trust Fund. A system for processing claims for recipients of this group is currently in development. Claims for any Medicaid services provided for NOW Trust Fund recipients of waiver slots will not be accepted until after January 1, 2009. At that time, all claims for these recipients will be held as "pending" with a tentative payment begin date of February 1, 2009. However, providers will be notified as soon as programming is completed, and payment of the pending claims will move forward for final processing at that time.

PHARMACY PROVIDERS PLEASE NOTE!!!

The Louisiana Legislature has funded additional New Opportunity Waiver slots through the NOW Trust Fund. A system for processing claims, including pharmacy services, for these recipients is currently in development. All claims for Medicaid services provided for NOW Trust Fund recipients of waiver slots will not be accepted until after January 1, 2009. At that time, pharmacy claims for these recipients will be processed for approval via POS and if all applicable edit criteria are met, the claim will receive a paid status on the POS response. Payment will be held until all financial programming is in place. We plan on a tentative payment begin date of February 1, 2009. However, providers will be notified as soon as programming is completed and payment of the "held" claims will move forward for final processing at that time.

ATTENTION DENTAL PROVIDERS

Effective for dates of service on and after December 24, 2008, changes will be imposed for the EPSDT Dental Program including increased reimbursement for certain procedures, revised policy regarding root canals, and coverage of five additional procedures. Implementation of these changes may be delayed if required programming changes are not complete; however, if this occurs, Medicaid will recycle affected claims. Complete details will be placed on the www.lamedicaid.com website under the "New Medicaid Information," "Billing Information," and "Fee Schedule" links. If you have questions, you may contact the LSU Dental Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free).