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 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.

    Attention: All Providers

    Revisions have been made to the on-line Medicaid Recipient Insurance Information Update form found in lamedicaid.com. A drop-down box was added to the TO: field listing all 5 Bayou Health plan's names, fax and phone numbers, as well as DHH's fax and phone number. Providers should select and fax the form to the correct Bayou Health plan for each Medicaid recipient. If the recipient is still in traditional Medicaid (no plan), the form should be faxed to DHH. This will assure that the appropriate persons are receiving the forms and completing the updates in a timely manner. The previous form is now obsolete so this form should no longer be submitted. Please use revised form only. See instructions below to locate form in lamedicaid.com.

    Click on Forms/Files/User Manuals on the left navigational bar. Then, click on Online Forms. Scroll down to Medicaid Recipient Insurance Information Update Form - Private Insurance Plans and Medicare Advantage Plans. Fill in form, print and fax to the plan or DHH.

    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.

    Bayou Health Administrative Corrections for Retroactive Enrollment and Retroactive Disenrollment Monthly Process

    DHH identified paid claims associated with administrative corrections of member�s linkages into Bayou Health Plans. These linkage corrections were necessary to ensure compliance with internal policies, approved Medicaid State Plan and maintaining audit controls.

    Beginning March 17, 2015, the process of voiding identified paid claims by an incorrect entity (Shared Plans: CHS & UHC, and Legacy Medicaid) will be repeated on a monthly basis to occur mid-month for administrative corrections made to member linkages in the prior month. Molina will void all identified paid claims with a denial reason code 999 Administrative Correction which is shown on the Remittance Advice.

    In order to rebill, providers must verify the correct entity based on the date of service by using either MEVS or REVS. To obtain consideration for payment, providers are required to submit claims to the correct entity no later than 6 months from the date the claim is voided. If PA or Pre-Cert was obtained on the original claim, providers will not be required to obtain additional authorization when submitting these specific prior-paid claims to the correct entity. Documentation must accompany claims verifying the void.

    This documentation of prior payment will also support the authorization of the service. Claims submitted within 6 months of the void date will not be denied based on timely filing.

    NOTE: Pharmacy claims should not be resubmitted through the Molina POS. All Pharmacy claims should be submitted using the NCPDP universal claim form accompanied by documentation verifying the void.

    For more information, please visit www.makingmedicaidbetter.com or lamedicaid.com "Attention All Providers: Bayou Health Administrative Corrections for Retroactive Enrollment and Retroactive Disenrollment-Monthly void process will begin March 17, 2015".

    Questions may be sent to Bayou Health at bayouhealth@la.gov, with the subject lined addressed to "Retro Claims".