RA Messages for March 31, 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.
the PBM HELP DESK at
1-800-648-0790.
Please note the
following changes to Appendix A
DRUG
DOSE
STRGTH LMAC
EFF
NORMAL SALINE DISP. SYRINGE
2ml 0.9%
off MAC 3/19/09
NORMAL SALINE DISP. SYRINGE
2.5ml 0.9%
off MAC 3/19/09
NORMAL SALINE DISP. SYRINGE
3ml 0.9%
off MAC 3/19/09
NORMAL SALINE DISP. SYRINGE
5ml 0.9%
off MAC 3/19/09
NORMAL SALINE DISP. SYRINGE
10ml 0.9%
off MAC 3/19/09
NORMAL SALINE IV SOLUTION
25ml 0.9%
off MAC 3/19/09
NORMAL SALINE IV SOLUTION
50ml 0.9%
off MAC 3/19/09
NORMAL SALINE IV SOLUTION
100ml 0.9% off MAC
3/19/09
NORMAL SALINE IV SOLUTION
150ml 0.9% off MAC
3/19/09
NORMAL SALINE IV SOLUTION
250ml 0.9% off MAC
3/19/09
NORMAL SALINE IV SOLUTION
500ml 0.9% off MAC
3/19/09
NORMAL SALINE IV SOLUTION
1000ml 0.9% off MAC
3/19/09
NORMAL SALINE VIAL
2ml 0.9%
off MAC 3/19/09
NORMAL SALINE VIAL
10ml 0.9%
off MAC 3/19/09
NORMAL SALINE VIAL
20ml 0.9%
off MAC 3/19/09
NORMAL SALINE VIAL
100ml 0.9% off MAC
3/19/09
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.
TAKE CHARGE/FAMILY PLANNING
WAIVER PROVIDERS
Medicaid does NOT cover Essure
(procedure codes 74740, 58565 and 58340)
for Take Charge. In early March DHH told some providers it was a covered service
but we cannot cover this service until we update the waiver documents with federal government and receive CMS approval. DHH apologizes
for the miscommunication and will keep providers updated via RA messages
and provider updates.
ATTENTION EARLYSTEPS PROVIDERS
EarlySteps claims for select
procedures provided in the Natural Environment and impacted by the reimbursement rate change effective for dates
of service 9/1/08 and after are being systematically adjusted to reflect
the updated reimbursement rates if the billed charges were greater than
the previous fee on file. These adjustments will appear on the RA of
3/31/09. No action will be required by providers. See the RA message
dated 1/20/09 for details.
Claims where the billed charges were less than or equal to the previous
fee on file will not be included in this systematic adjustment. For this
situation, if providers determine adjustments are needed, providers
should review the claim adjustment policy and procedures in the 2007
Louisiana Medicaid EarlySteps Provider Training manual, pages 31-36.
Contact Unisys Provider Relations at (800) 473-2783 or (225) 924-5040
with any questions.
ATTENTION PHYSICIANS AND
HEMODIALYSIS CENTER PROVIDERS
In order to prevent claims
requiring NDC data from processing differently during the same weekly cycle, the implementation of NDC denial edits
will occur on processing date Monday, 4/6/09, rather than Wednesday,
4/1/09. This will allow all claims submitted within the same weekly
cycle to process using the same logic instead of possibly having some
claims process and pay with educational edits and others deny. Please be
aware of this processing date change for NDC denials. Also, please remember that this affects claims with dates of service 3/1/08 forward.
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 PROVIDERSS
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.