RA Messages for April 6, 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

In correspondence sent in September 2009, we notified providers that pharmacy claims billed for recipients for palivizumab (Synagis) outside the RSV season would deny. To override the claim, pharmacists will be required to submit paper claims to Pharmacy Benefits Management, P.O Box 91030, Baton Rouge, LA 70821-9030. For documentation pharmacists will need a prescription handwritten in the prescriber's handwriting on the prescription. Providers may call 225-342-9768 with questions.

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 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.

ATTENTION PROVIDERS: CLAIMCHECK UPDATE

There is an additional provider notice dated March 19, 2010, regarding the implementation of 'ClaimCheck' posted to the Medicaid website. Providers are directed to information and updates regarding 'ClaimCheck' via the specific 'ClaimCheck' link at www.lamedicaid.com. Providers should visit this link frequently for the most current information on the upcoming 'ClaimCheck' claims editing implementation.

ATTENTION HOSPITAL PROVIDERS

Effective with dates of service on or after January 01, 2010, the reimbursement rates for some laboratory and radiology services for Outpatient Hospital providers are reduced. The codes being reduced are the result of having a rate on the Medicaid file that was in excess of the 2010 Medicare rate. Providers began seeing these reductions on the RA of February 23, 2010. Claims that were adjudicated prior to February 23, 2010, have been systematically adjusted on this RA (4/6/10) and no action is required by providers.

Any questions should be directed to Provider Relations.