RA Messages for January 18, 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 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.
 

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.

ATTENTION PHYSICIANS AND INPATIENT HOSPITAL PROVIDERS

Louisiana Medicaid is pleased to announce the implementation of the application Precert Inquiry. This web-based tool gives providers the ability to electronically check the status of inpatient hospital precertifications of Medicaid members. The ability to track the status of these requests online will create more efficient processes for providers and the Fiscal Intermediary.

This tool will be available to all inpatient hospitals and physician providers on January 18, 2011. The Precert Inquiry application is accessible through the secure Provider Login area at the Louisiana Medicaid website, www.lamedicaid.com.

For further information regarding this web-based tool, please visit www.lamedicaid.com. Click on "Forms/Files/User Manuals" on the left side of the homepage, then click on User Manuals and this will bring you to the link for the Precert Inquiry User Manual.

ATTENTION PROVIDERS

The provider rate reductions which were effective December 1, 2010, have been rescinded and replaced with comparable rate reductions that are effective January 1, 2011. These rate reductions have been implemented through Emergency Rules that were published in order for the state to avoid a budget deficit in the current fiscal year. For details regarding which services are affected by these reductions, please visit the Emergency Rule section of the Office of the State Register's website, http://doa.louisiana.gov/osr/. A summary of the January 2011 rate reductions can also be accessed on the Louisiana Medicaid website at www.lamedicaid.com.

DHH is currently working on programming to recycle claims that were paid for dates of service from December 1-31, 2010. Providers should monitor their weekly RA messages to determine when the particular services which they deliver will be systematically adjusted.

ATTENTION ALL PROVIDERS WHO PERFORM SERVICES
THAT REQUIRE PRIOR AUTHORIZATION

On 9/1/10, a claims processing problem occurred that allowed some claims that require prior authorization (PA) to process and pay without verifying the required prior authorization during the payment cycle. The problem was identified and corrected. However, approximately 1,550 claims for providers whose services require prior authorization were processed without authorization validation prior to the correction of the problem. These claims that were paid without authorization validation will be voided on the RA of 1/18/11. The claims will then be recycled and reprocessed with the appropriate authorization validity checks on the RA of 2/1/11. When recycled, some of these claims may pend or deny if the service authorization is not in place to allow payment of the claims. In these cases, providers should review the pend or denial edit and take corrective action as indicated in order to have the service considered for payment. We apologize for any inconvenience caused by this error. Please contact Molina Provider Relations at the number below should you have any questions.
 

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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.