RA Messages for March 09, 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 MEDICAID PROVIDERS
EFFECTIVE IMMEDIATELY: 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. These reductions were initially delayed, but systems logic is now effective, and providers will begin seeing these reductions on the 3/9/09 RAs. Systematic adjustments to affected previously paid claims will occur in the near future. No action is required by providers.

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/). Providers should visit the Louisiana Medicaid website (www.lamedicaid.com) for information regarding the rate reductions and effective dates.

ATTENTION MEDICAID PROVIDERS
ADDITIONAL REIMBURSEMENT RATE REDUCTIONS- ASC, CRNA, ESRD, LAB & X-RAY

Effective with date of service February 26, 2009, rate reductions were implemented for the following programs: Ambulatory Surgical Centers (non-hospital), Professional Services Program Anesthesia Services- Certified Registered Nurse Anesthetists, End Stage Renal Disease Facilities and Laboratory & Radiology services. Emergency rules for reimbursement rate reductions were published for these on or before February 25, 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/). Claims paid at inappropriate rates due to delay in implementation will be systematically adjusted and no action is required by providers. Providers should monitor future RAs for updates regarding these rate reductions.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
"QW MODIFIER UPDATE"

Please note that the system has been updated and the following CPT codes require a QW modifier: Effective with date of service 10/4/2006: codes 82042, 82150, 82247, 82977, 84075, 84157, 84520 and 87808. Effective with date of service 10/22/2007: code 86703. Effective with date of service 10/30/2007: code 80051. Effective with date of service 1/1/2008: code 80047. Effective with date of service 1/16/2008: codes 80048 and 80053.

Claims that previously denied due to error 386 (Not Payable with CLIA Cert Type) for the aforementioned procedure codes were systematically adjusted with the RA of 2/17/2009.

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.

PROVIDER ALERT
ERROR IN PROCESSING IMMUNIZATION ADMINISTRATION REIMBURSEMENT

Providers were notified through an RA message on 2/24/09 that claims affected by a recent rate adjustment of certain immunization administration codes were systematically recycled on the RA of 2/24/09. A file error caused these claims instead to deny on the 2/24/09 RA with edit 799. The correct file will be systematically recycled on the RA of 3/3/09. Please disregard the erroneous 799 denials from 2/24/09. Providers do not need to take any action. We apologize for any inconvenience this may have caused.

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.