RA Messages for January 20, 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.  

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
2009 HCPCS: Status Update

 The Louisiana Medicaid files have been updated to reflect the new and deleted HCPCS codes for 2009. Appropriate editing and coverage determinations for the new codes is still underway and systematic adjustments for some previously processed claims may be necessary in the future. Providers will be notified and no action is required by providers. The 2009 'Current Procedural Terminology' manual includes information on the appropriate reporting of the new codes. It is the intent of Louisiana Medicaid that these instructions be followed. All payments are subject to post payment review and recovery of overpayments.

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).

ATTENTION EARLYSTEPS PROVIDERS

Effective with date of service September 1, 2008, reimbursement rates for select EarlySteps services provided in the Natural Environment have been updated. The updated rates can be found on the EarlySteps Fee Schedule located on the Medicaid website, www.lamedicaid.com, following the Fee Schedules link. Affected claims paid at the previous rate will be systematically adjusted in the near future if the billed charges were greater than the previous fee on file. No action will be required by providers. Please monitor your RA's for the specific date(s) the adjustments will take place.

DHH policy states providers are to enter their usual and customary charges for services rendered. Claims where the billed charges were less than or equal to the previous fee on file will not be included in this systematic adjustment. For this situation, if providers determine adjustments are needed, providers should review the claim adjustment policy and procedures in the '2007 Louisiana Medicaid EarlySteps Provider Training' manual, pages 31-36. Contact Unisys Provider Relations at (800) 473-2783 with any questions.

ATTENTION SCHOOL BASED HEALTH CENTERS (SBHC)

Following the recent KIDMED system merge on December 1, 2008, we were made aware of the fact that SBHC KIDMED claims for children 10 and over are denying with edit 424 (Billing provider is not the designated provider of record). The problem causing these denials has been corrected and applicable claims that denied for this edit on RAs since the merge have been systematically recycled and appear on the January 20, 2009 RA. Please note that any claim denials for recipients under age 10 will not be recycled. Please contact Unisys Provider Relations at (800) 473-2783 for questions related to this recycle.

ATTENTION PHYSICIANS, HOSPITALS, AND LICENSED HEMODIALYSIS CENTERS

Effective with processing date April 1, 2009, the educational edits related to submitting NDC data on claims for physician-administered drugs will become denial edits for professional claims, outpatient hospital claims, and hemodialysis claims. Claims that do not contain the required, accurate NDC information submitted as directed in the billing instructions will deny. These edits are 120, 127, and 231. Online provider training sessions or Webinars concerning this implementation will be held in early February for affected providers. The announcement of this training will be posted on the LA Medicaid website, www.lamedicaid.com. Affected providers should review this site to register as registration will be required to attend. Training materials will be posted on the website Training link following the sessions for those who are unable to attend. Please visit this website and ensure that you have reviewed the training materials and provider notices in preparation for the April 1 implementation date.