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 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.

ATTENTION ALL NON-PHYSICIAN PROVIDERS

DHH has scheduled an additional claims processing cycle for all non-physician providers for the last week of March. The remittance advice dates for that week are: Tuesday 03/29/11 and Thursday 03/31/11. Please alert your staff, your accounting department, and any impacted business partner, including submitters and billing agents, of this addition. All claims submitted by physicians will be processed during the regular cycles of 03/29/11 and 04/05/11. It is important to note that the EDI deadlines for the last 2 weeks of March are:

03/24 (Thursday) at 3PM for the 03/29 processing cycle;
03/29 (Tuesday) at noon for the 03/31 processing cycle;
and 03/31 (Thursday) at noon for the 04/05 processing cycle.

For additional information refer to article on lamedicaid.com.