RA Messages for March 24, 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. 

LUPRON DEPOT THERAPY FOR PROSTATE CANCER

Updates have been made to the claims processing system to allow reimbursement for multiple units of Lupron Depot 7.5mg IM (J9217) to be administered on the same date of service to a recipient when medically indicated for the treatment of prostate cancer. It continues to be the Department's intent that provision of this medication other than for the treatment of prostate cancer is not reimbursable in Medicaid's 'Professional Services' program. A systematic adjustment of inappropriately denied or 'cutback' claims will be made. No action is required by providers. Notification will be made via remittance advice messages when the adjustments occur in the near future.

NOTICE TO HOSPITAL PROVIDERS
DELAY IN IMPLEMENTATION OF NDC DENIAL EDITS FOR OUTPATIENT
HOSPITAL CLAIMS

DHH has learned that Medicare will implement the requirement for transmitting NDC data on electronically submitted claims effective 7/1/09. In an effort to allow hospital providers to make any systems changes needed to accommodate both the Medicaid and Medicare requirement, we are postponing the implementation of Medicaid claim denial edits related to the entry of NDC data on claims for outpatient hospital claims until 7/1/09.

Edits related to NDC claim data will continue to be educational edits through 6/30/09. The NDC edits are 120, 127, and 231.

The NDC data requirement is applicable for claims with dates of service 3/1/08 forward. Thus, any claim resubmittals with dates of service on or after 3/1/08 will deny beginning with processing date 7/1/09 if the necessary NDC data is not present on the claim.

This is the final delay by LA Medicaid of the implementation of claim denials.
 

ATTENTION DENTAL PROVIDERS

Increased reimbursement rates for certain procedures and coverage for additional procedures for the EPSDT Dental Program have been approved by CMS, effective for dates of service on and after December 24, 2008. Implementation of these changes will be delayed because required programming changes have yet to be complete; therefore, Medicaid will recycle affected claims. Complete details will be placed on the www.lamedicaid.com website under the "Billing Information" and "Fee Schedule" links. If you have questions, you may contact the LSU Dental Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free).

ATTENTION COMMUNITY MENTAL HEALTH CENTER (CMHC) PROVIDERS

At the request of the CMHC provider community, we are again extending the cut-off date for retroactive claims and will allow all CMHC providers to resubmit older, retroactive claims in an effort to "clean up" any unresolved claims left outstanding. Additionally, providers will be allowed to submit claims with dates of service from 1/1/2003 but MAY NOT SUBMIT any claims prior to their Medicare enrollment date. This is a change from the original 1/1/2005 effective date. Providers who meet the Medicare enrollment criteria and are interested in submitting claims with dates of service 1/1/2003-12/31/2004 must notify Unisys Provider Enrollment in writing with their request to change their Medicaid enrollment effective date and state the date requested. This request must be signed by someone affiliated with the CMHC who is authorized to make changes and sign on behalf of the provider and must be faxed to the Provider Enrollment unit at 225-216-6392.

This will be the final extension for these older claims, and the following procedures must be followed: (1) These claims may have dates of service from 1/1/2003 through 6/30/2008. (2) Any and all claims with these dates of service MUST be submitted electronically, regardless of whether the denial was caused by provider error or Unisys error. NO PAPER CLAIMS WILL BE ACCEPTED. This includes claims with TPL in addition to Medicare. (3) Claims must be submitted/resubmitted by 4/30/2009, and providers will be given a 2-month period from 5/1/2009-6/30/2009 to reconcile accounts and resubmit any denied claims for consideration. The final grace period ends on 6/30/2009.

Effective 7/1/2009 all CMHC crossover claims must be filed in accordance with timely filing guidelines. Please contact Unisys Provider Relations should you have questions.

Additionally, procedure codes G0410 and G0411 have been added to our claims processing system for submission on claims with dates of service 1/1/2009 forward. Claims with dates of service 1/1/2009 forward that have denied will be systematically recycled.

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.