RA Messages for January 11, 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 DENTAL PROVIDERS

Effective for dates of service on or after January 1, 2011, the dental procedure code D0272 will be reimbursable by Medicaid in the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Dental Program only once a year. Complete details can be located on the www.lamedicaid.com website under the "Dental Providers" link. Contact the LSU Dental Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free) with any questions.

ATTENTION HOSPITAL PROVIDERS: REIMBURSEMENT OF VAGUS
NERVE STIMULATORS

Effective June 14, 2010, a PA-01 Form is no longer required for hospital providers for the VNS device. However, reimbursement of the device continues to be dependent upon approval of the surgeon to perform the procedure. Hospitals should confirm that the surgeon has received an authorization for the procedure prior to submitting their claim in order to prevent denials.

The hospital will bill their VNS claim using HCPCS procedure code C1767 (VNS generator) and/or C1778 (VNS leads) to Molina on a CMS 1500 claim form with the words DME written in red on the top of the form and the PA number written in Item 23 or through the electronic claims submission.

The claim will pend to the Molina Medical Review Department for review of the surgeon's approved PA request. If approved, the hospital claim will be allowed to process for payment; if there is no valid authorization, the hospital claim will deny with edit 191 (PA required).

If the recipient is Chisholm, the authorization for the device will be referred to PAL to assist the recipient in obtaining the necessary documentation to process the request. This may include identifying the surgeon to contact in order to assist with the submission of his/her prior authorization request.

ATTENTION ALL PROVIDERS (EXCEPT ATYPICAL)

In order to comply with federal requirements to include the National Provider Identifier (NPI) on all claims. Changes to current claims processing will be made over the next two months. Providers using the Molina Form 213 for Physician Crossover Adjustments, Professional Crossover Adjustments, Durable Medical Equipment Adjustments, Durable Medical Equipment TPL Adjustments, and Physician Adjustments will need to begin using the CMS-1500 claim form; providers using the Rehabilitation forms for claims and adjustments (102, 202) will instead be required to use the CMS-1500 form. Over the coming months, changes to Dental (209, 210), Pharmacy (211), and KIDMED (KM-3) claim forms will also be introduced to accommodate these federal requirements. Providers who have software vendors must alert their vendors of the changes. Please monitor the Louisiana Medicaid website, www.lamedicaid.com, for an implementation schedule and more details.
 

MEDICAID ADULT DAY HEALTH CARE WAIVER PROVIDER MANUAL

The Medicaid Adult Day Health Care Waiver Provider Manual has been posted to the Louisiana Medicaid Provider Support Center website (http://www.lamedicaid.com). It has an issue date of December 1, 2010. You can click on the following link to go directly to this manual: http://www.lamedicaid.com/provweb1/Providermanuals/ADHC/ADHC.pdf This direct link to the ADHC Waver manual will be posted to the OAAS internet website as is the case for both the EDA Waiver and LT-PCS Provider Manuals.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
PEDIATRIC CRITICAL CARE CODES OMITTED FROM 9/22 & 10/6 CLAIM ADJUSTMENTS

It has come to our attention that some claims for pediatric critical care codes were omitted from the systematic budget adjustments that occurred on the 9/22/10 and 10/6/10 RA's. Please note that the fees for these codes were implemented correctly and have been reimbursing appropriately since that time. Claims that required adjustment due to delayed implementation of the fee changes were not performed systematically. Providers wishing to adjust their claims can do so on an individual basis. Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 with questions concerning this issue and for assistance with adjustment of claims if needed.

ATTENTION ALL PROVIDERS
2011 HCPCS UPDATE

Louisiana Medicaid is in the process of completing the programming for the 2011 HCPCS updates. This includes both new and deleted codes for 2011. Every attempt is being made to have the new codes/updates on file by mid January 2011. 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.

ATTENTION PROFESSIONAL SERVICES PROVIDERS PROCEDURE CODES PAYABLE TO OPTOMETRISTS (UPDATED 1/11/11)

The Department recently updated programming logic for procedure codes payable to optometrists effective for dates of service Jan 1, 2007 forward. Claims that previously denied with errors 210 �PROVIDER NOT CERTIFIED FOR THIS PROCEDURE�, 298 �INVALID PROCEDURE CODE FOR DATE OF SERVICE� AND 299 �PROC/DRUG NOT COVERED BY MEDICAID� were systematically adjusted on the RA of Dec 21, 2010.  

As a result of this update, claims for eyeglasses (V codes) inadvertently denied on the RA�s of 12/14/10, 12/21/10, 12/28/10, 1/4/11, and 1/11/11. We are working to repair this issue so that claims should process correctly on the RA of 1/11/11 1/18/11. Claims that previously denied due to this issue will be systematically adjusted on the RA of 1/11/11 1/18/11. Continue to monitor www.lamedicaid.com and weekly RAs for further updates. Please contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning this issue.

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Contact Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225) 924-5040 should you have any questions related to the implementation of the rate reductions in any of the previous messages.