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 ALL PROVIDERS 2016 HCPCS UPDATE

Louisiana Medicaid is currently in the process of completing the 2016 HCPCS update. The Louisiana Medicaid files have been updated to reflect the deleted HCPCS codes for 2016. It is the Department's intent to have the new 2016 codes and updates on file as soon as possible including the appropriate editing and coverage determination for the new 2016 HCPCS codes.

Providers should submit claims for the appropriate HCPCS code to preserve timely filing. Claims denied due to the use of the new 2016 HCPCS codes not yet on file, will be recycled once the fee schedule updates are complete.

Most legacy Medicaid Fee Schedules on the Louisiana Medicaid website, www.lamedicaid.com, will be updated in the near future to reflect coverage of the new 2016 codes. Providers should monitor their RA messages for additional information.

New and Revised Place of Service Codes (POS) for Outpatient Hospital
Implementation Date 01-01-2016

The Centers for Medicare and Medicaid Services (CMS) made changes to the existing place of service code set by creating a new place of service (POS) code, code 19 (Off Campus-Outpatient Hospital), and revised the POS Code 22 (On Campus-Outpatient Hospital).

Louisiana Medicaid will accept POS 19 for any claims processed on or after January 1, 2016. That is, POS code 19 is valid for any claim, regardless of the date of service, when it is processed on or after January 1, 2016. The payment policies that currently apply to POS 22 will continue to apply to this POS, and will now also apply to POS 19.

CMS also issued minor corrections to POS codes 17 (Walk-in Retail Health Clinic) and 26 (Military Treatment Facility).

To access the CMS POS code set go to: https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html.

Should you have questions related to the place of service codes changes, please contact Molina Providers Relations at 1-800-473-2783. Questions regarding submission of claims to/payment by the correct entity should be directed to the MCO.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective January 12, 2016, Fee for Service pharmacy claims for Ombitasvir/paritaprevir/ritonavir (Technivie®) and Daclatasvir (Daklinza®) will have edits at Point of Sale (POS) similar to the other Hepatitis C direct acting antiviral agents. Please refer to www.lamedicaid.com for specifics.

Attention Durable Medical Equipment Prosthetics and Orthotics (DMEPOS) Providers 2016 HCPCS Update

HCPCS codes E0463 (Pressure Support Ventilator, Used with Invasive Interface) and E0464 (Pressure Support Ventilator, Used with Non-invasive Interface) will be removed from the Louisiana Medicaid DMEPOS fee schedule effective for date of service January 1, 2016. The codes have been discontinued by CMS.

Effective with date of service January 1, 2016, HCPCS code E0463 will be replaced with E0465 (Home Ventilator, Any Type, Used with Invasive Interface) and E0464 will be replaced with E0466 (Home Ventilator, Any Type, Used for Non-Invasive Interface). Reimbursement will be the same as the prior code.

The on-line fee schedule will be updated in the next few weeks. If you have questions regarding this matter contact Molina Provider Relation at 800-473-2783.

Attention ICF Providers, Nursing Home Providers and Hospice Providers
CMS required billing changes

Transaction standards updated under the Health Insurance Portability and Accountability Act of 1996 (HIPPA) with regard to ASC X12 Version 5010 require an attending provider be submitted on all institutional (format UB-04) claims. By definition the attending provider is an individual. In addition, CMS is also requiring the billing provider NPI information must also be identified on the claim form. An additional edit will be put into the system to deny claims missing the billing provider's information.

Please visit www.lamedicaid.com for detailed provider notices concerning these changes.

PROFESSIONAL MEDICARE CROSSOVER CLAIMS TO MOLINA CLAIMS DENIED FOR EDIT 204 IN ERROR- TO BE RECYCLED

In August, changes were made to claims processing logic which caused some professional Medicare Crossover claims that do not require an attending provider to erroneously deny with edit 204 (Billing Provider Not on Attending Provider Record on Date of Service). This issue has been corrected and the affected claims will be recycled on the 01/12/2016 RA. No action is required by providers to resubmit claims. These claims may deny for other edits. We apologize for any inconvenience this may have caused.

Should you have questions related to the voids, please contact Molina Providers Relations at 1-800-473-2783. Questions regarding submission of claims to/payment by the correct entity should be directed to the MCO.

Attention Home Health Providers
2016 HCPCS Update

HCPCS code G0154 (Direct skilled nursing services of a licensed nurse (LPN or RN) in the home health or hospice setting, each 15 minutes) will be removed from the Louisiana Medicaid Home Health fee schedule effective for date of service January 1, 2016. The code has been discontinued by CMS.

Effective with date of service January 1, 2016, HCPCS code G0154 will be replaced with G0299 (Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes) and G0300 (Direct skilled nursing services of a license practical nurse (LPN) in the home health or hospice setting, each 15 minutes). Reimbursement will be the same as the prior code.

The on-line fee schedule will be updated in the next few weeks. If you have questions regarding this matter contact Molina Provider Relation at 800-473-2783.

ATTENTION PROVIDERS: REMOVAL OF THE TWELVE (12) VISIT LIMIT:

Effective with dates of Service January 1, 2016 and forward, the twelve (12) visit limit per year in legacy Medicaid on outpatient professional services for adult recipients age twenty-one (21) years and older has been removed. This includes professional services provided in emergency rooms, outpatient hospital clinics, physician’s offices, Federally Qualified Health Centers (FQHC’s) and Rural Health Centers (RHC’s). All visits and services provided must be medically necessary but do not require authorization for reimbursement

Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.