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 PHARMACISTS AND PRESCRIBING PROVIDERS

Focalin XR will be moved to the PDL. Effective March 1, 2011, Focalin XR will no longer require Prior Authorization.


ATTENTION ALL PROVIDERS 2011 HCPCS UPDATE

The Louisiana Medicaid files have been updated to reflect the new and deleted HCPCS codes for 2011. Refer to the Professional Services Fee Schedule on the LA Medicaid website, www.lamedicaid.com. Claims denied due to use of the new 2011 codes prior to their addition to our system will be systematically adjusted on March 8, 2011, and no action is required from providers. Appropriate editing and coverage determinations for the new codes are still underway and systematic adjustments for some previously processed claims may be necessary in the future. Providers should continue to monitor RA messages for future updates for the 2011 HCPCS updates.

Additionally, the "Assistant Surgeon/Assistant at Surgery Covered Procedures List" under the 'ClaimCheck' icon on the website homepage will be updated to reflect the applicable 2011 procedure codes. As a reminder, 'ClaimCheck' uses the American College of Surgeons (ACS) as its primary source for determining assistant surgeon designations.

The 2011 'Current Procedural Terminology' manual includes information on the appropriate reporting of the new codes. It is the intent of Louisiana Medicaid that these instructions be followed. All payments are subject to post payment review and recovery of overpayments.

ATTENTION ALL PROVIDERS (EXCEPT ATYPICAL)

In order to comply with federal requirements to include the National Provider Identifier (NPI) on all claims, changes to current claims processing will be made over the next two months. Providers using the Molina Form 213 for Physician Crossover Adjustments, Professional Crossover Adjustments, Durable Medical Equipment Adjustments, Durable Medical Equipment TPL Adjustments, and Physician Adjustments will need to begin using the CMS-1500 claim form; providers using the Rehabilitation forms for claims and adjustments (102, 202) will instead be required to use the CMS-1500 form. Over the coming months, changes to Dental (209, 210), Pharmacy (211), and KIDMED (KM-3) claim forms will also be introduced to accommodate these federal requirements. Providers who have software vendors must alert their vendors of the changes. Please monitor the Louisiana Medicaid website, www.lamedicaid.com, for an implementation schedule and more details.

ATTENTION DURABLE MEDICAL EQUIPMENT (DME) PROVIDERS

Please note the following DME HCPCS codes which are being discontinued (12/31/2010) and the appropriate replacement codes which are to be submitted for prior authorization (PA) request dated 01/01/2011 forward. The PA requirements and medical necessity criteria that were applicable for the discontinued codes apply for the replacement codes.

Discontinued codes             Replacement codes
K0734                                E2622
K0735                                E2623
K0736                                E2624
K0737                                E2625

The payment amounts for the replacement codes are noted on the updated fee schedule which can be found on www.lamedicaid.com.

ATTENTION EARLYSTEPS PROVIDERS - SYSTEMATIC CLAIMS ADJUSTMENTS
FOR RATE REDUCTIONS EFFECTIVE JAN.1, 2011

The effective date for the 2% rate reduction for EarlySteps services provided in the natural environment has been changed from December 1, 2010 to January 1, 2011. Refer to the LA Medicaid website (www.lamedicaid.com) and the Office of the State Register's website at http://doa.louisiana.gov/osr for published rules detailing these reductions. The system has been updated to reflect this change. Claims for dates of services Dec 1, 2010-Dec 31, 2010 that were adjudicated prior to the new Jan 1, 2011 effective date will be systematically adjusted on the RA of March 15, 2011. Providers should reference the "Fee Schedules" link on the homepage of the LA Medicaid website (www.lamedicaid.com) for the most current fees. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the implementation of the rate reductions or adjustment of claims.

NOTICE TO PROVIDERS OF HOSPICE SERVICES
POLICY CLARIFICATION

Upon a revocation or discharge a patient will lose the remaining days in that election period. The individual may at any future time elect to receive hospice coverage for any other hospice periods for which he/she is eligible. Please visit www.lamedicaid.com for further details.

URGENT NOTICE: ALL MEDICAID PROVIDERS
CMS MANDATE - NATIONAL CORRECT CODING INITIATIVE (NCCI) EDITING
FOR MEDICAID SERVICES

Under new federal regulations signed into law in 2010, State Medicaid Agencies must incorporate and apply editing methodologies of the National Correct Coding Initiative (NCCI). CMS has granted some flexibility to the States to fully implement the editing into their systems until April 1, 2011.

For more detailed information related to this CMS mandate, including provider types affected and further explanation of the edits, providers are directed to the Louisiana Medicaid website at www.lamedicaid.com and the CMS website at www.cms.gov under the Medicaid links related to NCCI.