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 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.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
PROCEDURE CODES PAYABLE TO PODIATRISTS

Effective January 1, 2011, procedure codes 97597 and 97598 (Debridement, open wound, including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface areas) are payable to podiatrists. The system has been updated to reflect this change. Claims for dates of service January 1, 2011-April 4, 2011 that were adjudicated prior to April 5, 2011, will be systematically adjusted. Continue to monitor future RAs for details regarding when the recycle of these claims will take place. Please contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning this issue.

PROFESSIONAL SERVICES PROVIDERS:
'DUPLICATE' DENIALS AND MODIFIER UPDATE

Revisions have been made to the complex duplicate logic in the claims processing system. This revision is intended to address the use of many anatomical 'site-specific' and 'repeat procedure' modifiers. Along with the 'site-specific' modifiers, modifiers -76 (Repeat procedure or services by same physician or...) and -77 (Repeat procedure or service by another physician or...) will be recognized (see the ClaimCheck webinar presentation information under the ClaimCheck button on www.lamedicaid.com for a listing of the anatomic 'site-specific' modifiers). When these modifiers are used appropriately, the "exact duplicate" denials related to error 813 should be reduced. Providers are reminded that improper use of modifiers to bypass claim editing solely to maximize reimbursement will be subject to review and administrative sanction by Louisiana Medicaid. Additionally, as indicated in provider agreement provisions, providers are to report and refund any and all overpayments.

To reduce the administrative burden for providers, claims with dates of service July 1, 2009, and forward that included these 'site-specific' or the 'repeat' modifiers and previously received a 'duplicate' denial, have been recycled. This recycle appears on the RA of April 5, 2011. Providers should expect that some of the claims will continue to deny for the same error, especially when there have been multiple resubmissions. When applicable, some claims may deny for a different reason. For questions related to this update and recycle, please contact Molina Provider Services at (800)-473- 2783 or (225)-924-5040.