RA Messages for March 23, 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.

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.

FREEDOM OF CHOICE LISTS

Notice to all enrolled Direct Service Providers with the following provider types: Adult Day Health Care (ADHC), EDA Waiver - Companion Services, Environmental (Home) Modifications (Environment Accessibility Adaptations), Personal Emergency Response System (PERS) and Long Term Personal Care Services (LTPCS). It is the responsibility of your agency to insure the accuracy of the Freedom of Choice Lists by updating and maintaining your agency information that is presented to users via the Provider Locator Tool (PLT). In order to access and use the PLT update feature, providers must register and obtain a valid account at www.lamedicaid.com. The PLT system can be accessed at www.dhh.la.gov/ and through a link on the OAAS website.

ATTENTION HOSPITAL PROVIDERS

This is clarification on the necessity for hospitals to split bill inpatient claims:

Hospitals are required to split bill their inpatient claims when 1) the hospital changes ownership, or 2) at the end of the hospital's fiscal year, or 3) if total charges on the claim exceed $999,999.99.

Hospitals have discretion to split bill their claims as warranted by other situations that may arise.

Any questions should be directed to Provider Relations.

ATTENTION LABORATORY, RADIOLOGY, AND ASC (NON-HOSPITAL) PROVIDERS
IMPLEMENTATION OF REIMBURSEMENT RATE REDUCTIONS

Effective with dates of service on or after January 22, 2010, the reimbursement rates for laboratory and radiology services are reduced by 4.42% of the fees on file as of January 21, 2010. Effective with dates of service on or after February 5, 2010, the reimbursement rates for Ambulatory Surgical Centers (ASC) are reduced by 5% of the fees on file as of February 4, 2010. Refer to the emergency rules published on the Office of State Register's website (http://doa.louisiana.gov/osr/). Providers should reference the link entitled "Professional Services, Laboratory, Radiology and Ambulatory Surgical Centers (ASC) Fee Schedules" under the "Fee Schedules" link on the homepage of the LA Medicaid website (www.lamedicaid.com) for the most current fees. Providers will begin seeing these reductions on the RA of March 23, 2010. Claims that were adjudicated prior to March 23, 2010, will be systematically adjusted and no action is required by providers. Continue to monitor future RAs for updates regarding these adjustments.

ATTENTION ALL PROVIDERS

According to the latest CMS regulations for complying with 5010 electronic transaction standards, entities must be ready to begin testing in early 2011. All electronic transactions must be conducted using 5010 and NCPDP D.0 versions beginning January 01, 2012. Providers should check with their clearinghouse, submitter or software vendor to determine the status of their preparations for the 5010 standards. The implementation will most likely require changes to the software and/or systems that you use for billing payers, so it is important that you plan for these changes. Unisys and DHH are working on preparations to be able to meet the date for beginning 5010 testing. Also, we will periodically share resources and post updates regarding our progress to the lamedicaid.com website under the link titled HIPAA Information Center.

There was an error when printing the remittance advices dated 3/16/2010, therefore, we are reprinting and mailing a corrected version to all providers. Once you receive the second version, please destroy the first one. The error involved the shifting of payment information to the right and the truncation of the internal control number. There was no error in payments. The electronic version of remittances (835 files) did not have any issues. We regret any inconveniences this may have caused.

ATTENTION PROVIDERS THAT SUBMIT MEDICARE PART A CROSSOVER CLAIMS

Effective with date of processing March 23, 2010, LA Medicaid will begin processing Medicare Part A claim adjustments that electronically cross to Medicaid from the Medicare carrier through GHI (the Coordination of Benefits Administrator). It will no longer be necessary for providers to routinely initiate submission of Medicare adjustments as paper claims with EOMBs attached. Any adjustments received electronically from GHI between March 2nd and March 23rd will be processed on March 23rd and will appear on your RA of March 30, 2010. Thereafter, electronic adjustments will be processed as they are received from GHI. Of course, if for any reason an adjustment does not electronically cross to Medicaid through GHI, providers must submit them for processing using the process previously in place. As always, providers should allow ample time for Medicare claims, including adjustment claims, to be processed by Medicare and electronically cross to Medicaid before taking action to submit a claim. Work will begin immediately to allow Medicare Part B claim adjustments to be electronically accepted from GHI, also. You will be notified of the effective date once these changes are in place. Questions concerning this transition may be directed to Unisys Provider Relations at (800) 473-2783 or (225) 924-5040.