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.

Update to 'ClaimCheck' Product Editing - February 2014

McKesson's 'ClaimCheck' product is routinely updated by the McKesson Corporation based on quarterly and annual changes made to the resources used, such as Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), provider specialty society updates, the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule Database, and/or the National Correct Coding Initiative (NCCI).

The most recent updates to the 'ClaimCheck' product are pending finalization, but are expected in the next few weeks. Once implemented, providers can expect that most claims will continue to be edited in the same manner; but when applicable, claims may now pay or deny for a different reason.

For questions related to this information as it pertains to legacy Medicaid or Bayou Health Shared Savings Plans, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Take Charge Program Providers - Take Charge Reimbursement Rate Change

It has been brought to our attention that several procedure codes payable under the Take Charge Waiver did not pay at the correct reimbursement rate. Claims submitted after January 6, 2014 should pay at the correct rate. Claims submitted prior to January 6, 2014 will be recycled to correct the payment amount. We will send another RA message to notify providers of the date this recycle will occur. The Fee Schedule for Take Charge Waiver is available on the Louisiana Medicaid Website, www.lamedicaid.com.

Attention Pharmacists:

Effective February 20, 2014, prescriptions written for iloperidone (Fanapt®) will have a maximum daily dosage limit of 24 mg/day. Claims which exceed the maximum daily dosage limit will deny through Point of Sale (POS). See www.lamedicaid.com for more information.

ATTENTION PROVIDERS: ACA-Eligible Claims Recycle for Nurse Practitioners

RE: "ATTENTION PROVIDERS: ACA-Eligible Claims Recycle for Newly Attested Providers" posted on 1/27/2014.

CMS has issued a revision to the CMS 1500 08/05 form to the CMS 1500 02/12.

On 1/28/2014, Molina recycled ACA-Eligible claims paid under legacy Medicaid or Bayou Health Shared Savings plans (Community Health Solutions of America and United Healthcare Community Plan). The recycle inadvertently excluded claims rendered by Nurse Practitioners. Another recycle will be completed on the 2/10/2014 RA to address these claims in order to pay the ACA rate. This recycle does not include Nurse Practitioner claims that did not indicate a referring provider on the claim. Providers must correct and resubmit those claims in order to receive the enhanced payment.

ATTENTION ALL PROVIDERS 2014 HCPCS UPDATE

The Louisiana Medicaid files have been updated to reflect the new and deleted codes for 2014. Providers began to see these changes on February 4, 2014. Denied claims will be recycled pending further 'ClaimCheck' editing.

Molina is currently updating the Professional Services Fee Schedule and the Outpatient Hospital Fee Schedules on the Louisiana Medicaid Website, www.lamedicaid.com.

Updates to the McKesson 'ClaimCheck' product are pending finalization from McKesson and are expected in the next few weeks. When implemented, providers may see minor differences in National Correct Coding Initiative and 'ClaimCheck' editing.

Providers should monitor their RA messages for additional information.

REVISIONS TO THE CMS 1500 FORM
AND
PROGRAM CHANGES FOR TRANSITIONING TO THE NEW FORM

FORM CHANGES IMPACTING LOUISIANA MEDICAID:

The most significant change to the CMS 1500 02/12 form is the addition of 8 diagnosis codes to Form Locator 21 (for a total of 12 diagnosis codes) and the addition of an ICD Indicator (to specify whether ICD-9 or ICD-10 is being used). Other changes to the form, though minor, may impact procedures and/or instructions. As of February 10, Molina and Louisiana Medicaid will officially accept claims from providers currently billing on the CMS 1500 version 08/05 to submit claims on either the CMS 1500 version 08/05 or version 02/12.

Please note that as of April 30, 2014, Molina will only accept the new CMS 1500 version 02/12. This time period will allow providers ample time to make changes to internal systems. After this date, original claims and claim resubmissions must be submitted on version 02/12 - regardless of the date of service.

PROGRAM CHANGES TO TRANSITION TO THE CMS 1500 FORM:

As we implement the newly revised form, the following changes will be made to transition programs to the CMS 1500 claim form:

  • Professional providers (Physicians, DME, and Professional Crossover) currently using the proprietary 213 Adjustment/Void Forms will be required to use the CMS 1500 02/12 for that purpose.

  • Free Standing Rehabilitation Center providers will be required to transition from the currently used proprietary 102 Claim Form and 202 Adjustment/Void Form to using the CMS 1500 02/12 for original claims, for adjustment and for voids.

  • Until further notice, providers using the forms referenced in the bulleted items above should continue to submit claims on those forms. Additional information concerning timelines for these program transitions and new billing instructions will be forthcoming.

NOTE: A complete review of all changes to the CMS 1500 is available here:

http://www.nucc.org/images/stories/PDF/understanding_the_changes_to_the_0212_1500_claim_form.pdf

Please visit the Medicaid web site, www.lamedicaid.com, for upcoming information.