RA Messages for March 16, 2010

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 PROVIDER

Corrections to the recently mailed Preferred Drug List (PDL) are:

Page 7, Insulins & Related Agents, Levemir should be on "Drugs on PDL". Page 8, Proton Pump Inhibitors, Kapidex name has changed to Dexilant. The Preferred Drug List (PDL) will be updated on www.lamedicaid.com.

ATTENTION ALL PROVIDERS
2010 HCPCS UPDATE

 The Louisiana Medicaid files have been updated to reflect the new and deleted HCPCS codes for 2010. Refer to the Professional Services Fee Schedule on the LA Medicaid website, www.lamedicaid.com. Claims denied due to use of the new 2010 codes prior to their addition to our system will be systematically adjusted 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. Please note that LA Medicaid will continue to allow the use of consultation procedure codes at this time. Also, as a part of these editing and coverage determinations, the newly created procedure code A4264 (Permanent Implantable Contraceptive Device) has been placed in non-pay status effective January 1, 2010. Providers should continue to monitor RA messages for future updates for the 2010 HCPCS updates.

The 2010 '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 PROFESSIONAL SERVICES PROVIDERS
Global Surgery Period (GSP) Updates

It has come to Louisiana Medicaid's attention that a number of procedure codes were inadvertently omitted from our Global Surgery Policy (GSP) editing that should have been included. The system update is complete and is effective with DATE OF PROCESSING February 22, 2010, and will appear on the RA's from March 2, 2010, forward. Providers may see claim denials related to the GSP (Error Codes 690 or 691) on procedure codes that previously did not receive these denials. Providers can currently view the "GSP DAY" for individual procedure codes on the Professional Services Fee Schedule found on the Louisiana Medicaid website: www.lamedicaid.com, using the 'Fee Schedule' link.

Further updates on GSP editing are expected to occur related to the implementation of the McKesson 'ClaimCheck' claims editing product, currently scheduled for mid-May 2010. Updates related to 'ClaimCheck' implementation can be viewed via the specific 'ClaimCheck' link also on the Medicaid website. Providers are encouraged to visit this site frequently for the latest information on 'ClaimCheck'.

ELDERLY AND DISABLED ADULT (EDA) WAIVER
ENVIRONMENTAL ACCESSIBILITY ADAPTATIONS (EAA)

Attention providers of Office of Aging and Adult Services Elderly and Disabled Adult (EDA) Waiver Environmental Accessibility Adaptations (EAA) (formerly Environmental Modifications) - Provider Type 15: Policy specific to the EDA Waiver service of EAA is posted to the Policy/Procedures section of the Publications page on the Office of Aging and Adult Services' website: www.oaas.dhh.louisiana.gov

IMPORTANT NOTICE REGARDING MEDSOLUTIONS' AUTHORIZATION NUMBERS

There has been an error on some MedSolutions authorizations where the case number was incorrectly shown as the Authorization Number on approval forms. This error occurred on authorizations issued between February 15, 2010, through February 24, 2010. MedSolutions will be sending corrected authorizations to the approved facility. You may also look up a patient authorization number at www.medsolutionsonline.com. Log in with your user ID and password and search the recipient/member ID. Please accept MedSolutions' apology for this error and inconvenience.

ATTENTION ALL LOUISIANA MEDICAID PROVIDERS

CommunityCARE PCP referral/authorizations are no longer required for administration of the H1N1 Influenza Vaccine. Effective with date of service, October 1, 2009, claims with CPT codes 90470 "H1N1 immunization administration (intramuscular, intranasal), including counseling when performed" and 90663 "Influenza virus vaccine, pandemic formulation, H1N1" will bypass error edit 106 (Billing provider not PCP). Claims for H1N1 vaccine administration that previously denied for error edit 106 will be systematically recycled.

TAKE CHARGE FAMILY PLANNING WAIVER COVERAGE
REMOVAL OF PROCEDURE CODES

The TAKE CHARGE Family Planning Waiver Program will be removing 3 procedure codes from the list of approved codes for the program.
The codes are:

76830 - ECHOGRAPHY, TRANSVAGINAL
76856 - ECHOGRAPHY, PELVIC, REAL TIME
85025 - BLOOD COUNT; HEMO; PLAT COUNT

These codes will be made non-payable for all TAKE CHARGE recipients effective 3/25/2010. If a TAKE CHARGE recipient is in need of the above services, they will be responsible to pay for them out-of-pocket or the provider can refer to the nearest charity facility in the recipients' living area. It is the responsibility of the provider to inform the recipient of financial responsibility of any uncovered services before the service is rendered.