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.

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.

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.

ATTENTION ALL PROVIDERS 2015 HCPCS UPDATE

Louisiana Medicaid is currently in the process of completing the 2015 HCPCS update. The Louisiana Medicaid files have been updated to reflect the deleted HCPCS codes for 2015. It is the Department's intent to have the new 2015 codes and updates on file as soon as possible including the appropriate editing and coverage determination for the new 2015 HCPCS codes. Providers should submit claims for the appropriate HCPCS code to preserve timely filing. Claims denied due to use of the new 2015 HCPCS codes not on file yet, will be recycled once the fee schedule updates are complete.

The Professional Services Fee Schedule and Outpatient Hospital Fee Schedule on the Louisiana Medicaid website, www.lamedicaid.com will be updated in the near future to reflect coverage of the new 2015 codes. Providers should monitor their RA messages for additional information.

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

Effective January 21, 2015, clinical pre-authorization will be required on pharmacy claims for ADHD/ADD medication prescriptions for recipients <48 months old. Please refer to www.lamedicaid.com for specifics.

TO ALL DME PROVIDERS

Effective December 15, 2014, portable oxygen equipment will be reimbursed for members who need continuous oxygen and require portable units while en route to a doctor's office, hospital or medically necessary appointment. Documentation of medical necessity as well as the anticipated number of visits per month needed must be submitted by the member's treating physician with the prior authorization request. Portable systems will not be approved to be used on a standby basis only. Units will be authorized per month based on review of submitted medical justification. An example of justification for refills includes, but is not limited to, multiple weekly visits for radiation or for chemotherapy. For recipients under age 21 only, portable oxygen may be approved when needed for travel to and from school.

All requests for portable oxygen should be submitted using the following procedure codes:

E0430-07 - Portable gaseous oxygen system (rental -includes regulator, flow meter, humidifier, cannula or mask, and tubing)

E0430-09 - Portable gaseous oxygen system (purchase - includes regulator, flow meter, humidifier, cannula or mask, and tubing)

E0443-09 - Portable oxygen contents, gaseous, l month's supply = 1 unit