RA Messages for February 24, 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 LTC PROVIDERS

When entering the Number of Days in the Value Code Fields 39, 40 or 41 of hard copy/paper UB claim forms, you MUST correctly follow the billing instructions which state: "Enter the appropriate Value Code in the "Code" portion of the field and the Number of Days in the "Dollar" portion of the "Amount" section of the field. Enter "00" in the "Cents" portion of the "Amount" section of the field."

Failure to enter "00" in the "Cents" portion of the field OR entering the number of days in the "Cents" portion of the field will cause the claim to deny. Additionally, these same instructions must be followed when submitting hard copy Medicare Crossover claims that do not cross automatically from the Medicare carrier. Failure to enter co-insurance days on Medicare crossovers when appropriate will result in claims denials for Code 087. Please make any needed changes to your software and/or procedures to ensure that this information is entered correctly on all paper claims for Medicaid.
 
Contact Unisys Provider Relations at (800)473-2783 or (225)924-5040 if you have questions concerning these instructions.

PROFESSIONAL SERVICES PROVIDERS
"Digital Mammography"

Effective with date of service July 1, 2008, Louisiana Medicaid will reimburse for digital mammography services, currently HCPCS codes G0202 (Screening mammography, producing direct digital image, bilateral, all views), G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views), and G0206 (Diagnostic mammography, producing direct digital image, unilateral, all views).

Providers should perform the most clinically appropriate method (film or digital) specific to the recipient. One screening mammography is allowed (either film OR digital) per female recipient aged 40-99, per calendar year.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
2009 HCPCS UPDATE

 Claims denied due to use of new 2009 codes prior to them being added to our system will be recycled and appear on the RA of 2/17/09.

ATTENTION ALL PROVIDERS

You were notified several weeks ago about the funding of additional NOW waiver slots through the NOW Trust Fund. At that time, you were notified that the addition of these slots was effective on or after November 3, 2008. The correct date for the addition of these slots is October 1, 2008. You were also informed that a system for processing the claims for these recipients was under development and any associated claims were pending, awaiting this development. The claims system is now complete, and any claims submitted for waiver recipients in NOW Trust Fund slots will now process correctly through the claims processing system.

ATTENTION MEDICAID PROVIDERS
DELAYED IMPLEMENTATION OF REIMBURSEMENT RATE REDUCTIONS

In order to avoid a budget deficit in the medical assistance programs, the Department of Health and Hospitals has determined that reimbursement rate reductions are necessary. For details regarding what services are affected by these reductions as well as the effective date of the reductions, please refer to the emergency rules published on January 30 or 31, 2009 in the legal notice section of the major daily newspaper in your area or the emergency rule section on the Office of the State Register's website (http://doa.louisiana.gov/osr/). No action is required by providers. Systematic adjustments to affected paid claims will occur in the near future. Providers should monitor the Louisiana Medicaid website (www.lamedicaid.com) for updates regarding the rate reductions and effective dates.

ATTENTION PROVIDERS OF ADULT IMMUNIZATIONS
RECYCLE: DENIED CLAIMS

Effective with date of service 10/1/07, LA Medicaid made select vaccine CPT procedure codes payable to professional service providers for adult recipients ages 21 and older. See the RA messages dated 11/13/07 and 10/28/08 for details. Affected claims that denied for services provided on or after 10/1/07 will be systematically recycled on the RA of 2/24/09. If providers determine the need to resubmit any claims, voids, or adjustments after this recycle is complete in order to rectify any outstanding issues, providers should review the claim void/adjustment policy and procedures in the 2007 Louisiana Medicaid Professional Services Provider Training, pages 121 and 128. Contact Unisys Provider Relations at (800) 473-2783 with any questions.

ATTENTION PROVIDERS OF IMMUNIZATIONS
RECYCLE: IMMUNIZATION ADMINISTRATION REIMBURSEMENT CHANGES

 Immunization administration procedure codes impacted by the reimbursement rate changes effective for dates of service 8/6/08 and after are being systematically adjusted and will appear on the RA of 2/24/09. See the RA message dated 12/16/08 for details. 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 KIDMED Provider Training, pages 38 and 64 or the 2007 Louisiana Medicaid Professional Services Provider Training, pages 121 and 128. Contact Unisys Provider Relations at (800) 473-2783 with any questions.