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
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.

Attention: All Providers

Effective 2/1/2015, all LaHIPP claims with dates of service 2/1/2015 forward will be paid using the cost comparison methodology used to pay TPL claims for non-LaHIPP recipients with primary insurance. All LaHIPP claims with dates of service prior to 2/1/2015 will continue to be processed paying the full patient responsibility (co-pay, co-insurance, and/or deductible). Also, effective 2/1/2015, e-MEVS, MEVS, and REVS will no longer identify Medicaid recipients with LaHIPP by the response "This Recipient is Enrolled in LAHIPP".

If you have questions, please call Jackie Porta @ 225-342-9463 or Danny Murnane @ 225-342-4902. Thank you for your cooperation in this matter.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid (Legacy/Fee for Service) Pharmacy Program:

Effective February 4, 2015, clinical pre-authorization will be required on pharmacy claims for Latuda® (Lurasidone), Fanapt® (lloperidone), and Saphris® (Asenapine) for recipients less than 18 years old. Please refer to www.lamedicaid.com for specfics.

ATTENTION OBSTETRICAL SERVICES PROVIDERS:

Reimbursement of delivery codes including antepartum care is intended for providers only when billing third party coverage. Providers are reminded that they may not bill for services that they did not provide. This includes postpartum care prior to providing that service.

Legacy Medicaid policy related to the billing of prenatal care has not changed. Please see the Professional Services provider manual on the Medicaid website, www.lamedicaid.com. Claims submitted for reimbursement of delivery codes including antepartum care for recipients not involving third party coverage are subject to Program Integrity review and recoupment.

For questions related obstetrical services through the Legacy Medicaid Professional Services program, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS: OUTPATIENT VISIT EXTENSIONS

The Louisiana Medicaid program has updated policy related to outpatient visit extensions. The criteria for approval has changed. Extension requests that have been reviewed and deemed medically necessary will be approved. Providers should refer to the revised policy located under "Exclusions and Limitations" in the Professional Services Provider Manual.

The Department is currently revising the Physician Outpatient Visit Extension Form (158-A). Providers should continue to use the current form located on the Medicaid website, www.lamedicaid.com until the revised form is available.

For questions related to the outpatient visit extensions updated policy for the Professional Services program, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION PROVIDERS SUBMITTING SHARED PLAN CLAIMS WITH A 52 MODIFIER
(REVISED)

While reviewing Shared Plan paid claims from UHC and CHS with dates of service back to 2/1/12 , we have found two issues related to claims submitted with a 52 modifier appended to procedure codes which were paid in error:

  • Some of these paid claims were actually aborted procedures rather than reduced services, and aborted procedures are not payable.

  • Claims were submitted electronically to the Plans without proper documentation to support the use of the 52 modifier.

Changes have since been made to Molina's system to prevent inappropriate payment of these claims.

On the RA of 01/27/15, claims for reduced services that were approved by UHC and CHS will be reprocessed to ensure that providers receive the correct payment.

On the RA of 2/10/15, Molina will void inappropriate payments made for aborted services and for reduced services that were submitted electronically to the Shared Plans.

ATTENTION SPEECH THERAPY PROVIDERS

It was recently noted that codes 92521, 92522, 92523, and 92524, effective January 1, 2014, were inadvertently loaded with a PAC (pricing action code) 8FO instead of a PAC 850. This resulted in claims for outpatient hospitals paying incorrectly at a cost to charge ratio instead of the published fee schedule rates for these codes. The PAC for these codes has been corrected. Claims will be systematically recycled without any action required on behalf of the provider.

Please contact Molina Provider Relations (800)473-2783 or (225) 924-5040 for questions.

ATTENTION PODIATRISTS:
PODIATRY CODES UPDATED

The Louisiana Medicaid program has recently updated Healthcare Common Procedure Coding System (HCPCS) codes billable for Podiatry services. The following HCPCS codes have been added to the listing on Appendix G located in the Professional Services provider manual on the Louisiana Medicaid website at www.lamedicaid.com: E0114, L1971, L2114, L3000, L4360, and L4396. The Department is in the process of adding the following Current Procedural Terminology (CPT) codes: 11045-11047. Podiatrists may resubmit denied claims for those Podiatry services recently added to Medicaid policy.

It is the Department's intent to allow Podiatrists to bill services within their scope of practice. However, only those Podiatry services included within Louisiana Medicaid policy will be reimbursed. Podiatrists are expected to bill the most appropriate procedure code for the services provided. Claims related to Podiatry services are subject to Program Integrity review and recoupment.

For questions related to Podiatry policy and billing for legacy Medicaid, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Managed Care Plans and Legacy Medicaid:

The Department is requesting that all prescriptions that are filled for both Medicaid Fee for Service and Medicaid Managed Care recipients and not picked up within 14 calendar days be reversed in your pharmacy computer system and returned to stock.

ATTENTION PROFESSIONAL SERVICES PROVIDERS:
RECYCLE OF DENIED INFLUENZA VACCINE CLAIMS

It has been brought to the Department�s attention that claims related to influenza vaccines, Current Procedural Terminology (CPT) codes 90686 and 90688 were inappropriately denying. Logic in the system has been corrected to allow these claims to pay correctly. All impacted claims with date of service on or after July 1, 2014 will be reprocessed on the Remittance Advice (RA) of February 17, 2015. No action is required by providers.

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

URGENT: Attention DME Providers
National Correct Coding Initiative (NCCI) Procedure to Procedure Edits
Implemented for DME Services

Providers were reminded in December 2014 that the Affordable Care Act requires States to incorporate NCCI edits and methodologies for Medicaid claims processing, including DME claims. Effective with date of processing February 24, 2015, NCCI �procedure to procedure� edits are being implemented for DME services. This will impact any date of service.

Please continue to refer to notices at www.lamedicaid.com for additional information as quarterly updates are made. 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.

�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.

Please note the following important information:

  • Although a procedure or procedures may be authorized through the Molina Prior Authorization Unit, this authorization does not guarantee payment of services. Claims will process through the NCCI edits during claims processing and inappropriately billed services previously authorized may deny at that time.
  • Providers may NOT bill recipients for services denied by NCCI edits.
  • Providers can 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, and 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.�
  • Providers who bill procedure code K0739 with modifier �RP to identify they are billing �Repair for DME - Parts Use RP Modifier� may see edit message 933: �Invalid procedure-modifier combination/ClaimCheck�. This is an informational message to educate providers that the modifier billed is not valid with the procedure code. This is NOT a denial at this time. Please note that future instructions for the billing of this procedure code and the appropriate modifier will be forthcoming.

    • For questions related to this information as it pertains to Legacy Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

    Each Bayou Health Managed Care Organization (MCO) is required to implement NCCI editing, but may have slightly different implementation schedules and billing policy related to the mandate. Please contact each MCO for information specific to that plan if there are processing questions. See Informational Bulletin 12-27 on the Making Medicaid Better website at www.makingmedicaidbetter.com, for the MCO contact information.

    Attention Long Term Care, ICF-DD and Hospice (room & board) Providers:

    During the Long Term Care processing cycle for the remittance advice dated 02/10/15, a file error occurred that caused some LTC claims to be left out of the cycle and the affected providers were not paid. This included some nursing homes, ICF-DDs, and Hospice providers Room and Board claims.

    DHH has authorized running a special mid-week check write to process these claims. This special processing run will take place on Wednesday, 2/11/15 with payment and Remittance dated Thursday, 2/12/15, with EFT deposits on Friday, 2/13/15. Also included will be LTC claims received from Friday 2/6/15 after EDI cut-off up to Wednesday 2/11/15 EDI cut-off.

    We apologize for any inconvenience this has caused to the affected providers.