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 regarding Invalid Codes:

It has been brought to the attention of DHH that a few long standing invalid procedure codes were still listed on the Professional Services fee schedule. This has been corrected and the invalid procedure codes, 99289, 99290, and 99436 have been made non-payable on all types of service and will no longer appear on the fee schedule once the next monthly update is posted. Providers should refer to the Current Procedural Terminology (CPT) manual for the appropriate billing codes and follow current CPT guidelines.

ATTENTION ALL PROVIDERS 2013 HCPCS UPDATE:

Louisiana Medicaid is currently in the process of completing the 2013 HCPCS update. The Louisiana Medicaid files have been updated to reflect the deleted HCPCS codes for 2013. Every attempt is being made to have the new codes and updates on file as soon as possible which includes appropriate editing and coverage determination for the new codes.

The Professional Services fee schedule on the La Medicaid website, http://www.lamedicaid.com/ will be updated in the near future to reflect these changes. Providers should monitor their RA messages for additional information.

ATTENTION DENTAL PROVIDERS:

Effective for dates of service on and after January 1, 2013, procedure code and nomenclature changes will be reimbursable by Medicaid in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Dental Program. Applicable policy and reimbursement information will be located at http://www.lamedicaid.com/ under the "Dental Providers" link. If you do not have web access and wish to request a hardcopy of the revised information and fee schedules, you should contact Molina Provider Relations as soon as possible by calling (800) 473-2783.

Attention All Providers:
Billing Medicaid Recipients for Services

This message is to remind all providers that within your agreement of participation with Louisiana Medicaid you agree to accept the Medicaid payment as payment in full for services rendered to Medicaid recipients, providing for the allowances for co-payments authorized by Medicaid.

A recipient may be billed for services that have been determined as non-covered or exceeding the services limit for recipients over the age of 21. Recipients are also responsible for all services rendered after his/her eligibility has ended. Providers may not bill recipients in instances where provider billing errors have caused a denied claim. In order to bill a recipient for a non-covered service, the recipient must be informed both verbally and in writing that he/she will be responsible for payment of the services.

We also want to remind you that providers are not required to accept every recipient requesting service. However, when a provider does accept a recipient, the provider cannot choose which services will be provided. The same services must be offered to a Medicaid recipient as those offered to individuals not receiving Medicaid, provided the services are reimbursable by the Medicaid Program. Providers must treat Medicaid recipients equally in terms of scope, quality, duration and method of delivery of services (unless specifically limited by regulation).

Update to 'CiaimCheck' Product Editing - January 2013
'Clear Claim Connection' Information

McKesson's 'ClaimCheck' product, used in claims processing, is routinely updated by McKesson Corporation. The most recent update is based on changes made to key industry mandates as well as enhanced modifier processing functionality. This update will affect claims processed beginning with the remittance advice of January 22, 2013, forward. Due to the enhancement, providers may notice minor differences in the clinical claims editing that include National Correct Coding Initiative (NCCI) and Outpatient Hospital edits. Providers should expect that most claims will continue to be edited in the same manner; but when applicable, claims may now pay or deny differently.

'Clear Claim Connection' is the related web-based reference tool that enables providers to access the editing rules and clinical rationale for some of the 'ClaimCheck' edits. This reference is in the process of being aligned with the updates to the editing product described above. Providers may see temporary differences when they use this tool until the corresponding update is made. Please keep in mind that 'Clear Claim Connection' is for reference only and the results are not a guarantee of how claims will finalize in the claims processing system.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800)473-2783 or (225)924-5040.