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 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.

ATTENTION PROFESSIONAL SERVICES PROVIDERS:

It has been brought to the Department's attention that code J1050, Medroxyprogesterone Acetate was inadvertently added to the Medicaid procedure file in 2013 without the appropriate budgetary reduction to the fee. This reimbursement amount has been corrected and the Professional Services Fee Schedule has been updated. All impacted claims will be recycled for potential recoupment and/or adjustments of funds on the RA of February 25, 2014. No action is required by providers.

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

TO ALL DME PROVIDERS

Effective March 1, 2014, all prior authorization requests for standing frames should be submitted using the standing frame criteria and form. This criterion has been updated in the DME provider manual and the standing frame form is labeled Appendix G. All standing frame requests submitted without the standing frame form will be denied.

Attention Pharmacists and Prescribing Providers

On the RA of January 28th some pharmacy claims were voided by providers through POS. On the RA of February 4th, these same claims were systematically voided again in error. We have generated manual pharmacy claims to offset the erroneous duplicate voids and these claims will appear on the March 4th RA. The ICN range of these manual claims is 4054888800001 to 4054888812908. We apologize for any inconvenience this may have caused pharmacy providers.