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 http://www.lamedicaid.com/. 

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

ATTENTION ALL PROVIDERS:
2015 HCPCS Claims Recycle/Fee Schedule Update

Claims that have been denied by legacy Medicaid due to use of the new 2015 codes not on file yet will be systematically recycled. Providers will see the recycle results on the RA of March 31, 2015. No action is required by providers.

The Professional Services, Laboratory and Radiology, and Outpatient Hospital "Non-Ambulatory" Surgery Fee Schedules have been updated on the Louisiana Medicaid Website, www.lamedicaid.com to reflect new 2015 procedure codes. The Department is working to get the Outpatient Hospital "Ambulatory" Surgery Fee Schedules updated as quickly as possible.

ATTENTION ALL MEDICAID PROVIDERS

Effective April 1, 2015, the Louisiana Medicaid web site will begin a transformation. The evening of March 31, 2015, a �facelift� will occur overnight! We will transition this site to a new look. The site becomes a part of the DHH Network, with the same color scheme and physical look of those web sites. The web site address, www.lamedicaid.com, will remain the same.

With this first phase of changes:

  • The Banner previously run across the top of the screen becomes �Alerts� at the top of the Home page.

  • Only 30 days of provider web notices will be maintained on the active Home page.

  • Notices over 30 days old that are currently located on the Home page will either be moved to appropriate directory links or will appear below the Home page notices on a new link, Additional Web Notices.

  • Notices initially housed on the Additional Web Notices link will be gradually moved from this link to the correct directory link.

  • Ultimately, all notices will be on the active Home page for 30 days and then transferred to the appropriate directory link.

In a future phase of this transition, the directory links and sub-links will be re-named and re-organized for a more "user friendly" experience. During the coming months, please watch for the announcements concerning additional changes to the site.

We hope the changes we are making will have a positive impact for you, our users, and thank you for your patience as we move forward with this transformation.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040. Thank you for your assistance in this matter.

Attention Durable Medical Equipment Prosthetics and Orthotics (DMEPOS) Providers

The DMEPOS Fee Schedule on the Louisiana Medicaid website, www.lamedicaid.com, have been updated to reflect the deleted and new 2015 HCPCS codes. The deleted codes removed from the DMEPOS Fee Schedule with the termination date of December 31, 2014:

  • A-7043: Vacuum drainage bottle and tubing for use with implanted catheter
  • L-7260: Electronic wrist rotator, Otto Bock or equal.
  • L-7261: Electronic wrist rotator, for Utah arm.

Effective with date of service January 1, 2015, Louisiana Medicaid will cover the following CPT procedure codes:

  • A4459: Manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type
  • A4602: Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each
  • A7048: Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each
  • K0901: Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated
  • K0902: Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated
  • L3981: Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments.
  • L6026: Transcarpametacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s).
  • L7259: Electronic wrist rotator, any type.
  • L8696: Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each

ATTENTION HOSPITAL PROVIDERS
BILLING LEGACY MEDICAID NEWBORN CLAIMS

Following the elimination of Inpatient Hospital Pre Certification requirements for Legacy FFS Medicaid claims, claims billed with Revenue Codes 172-175 for newborn babies have been identified as being incorrectly paid at a $0 amount. This issue has been resolved to provide appropriate payments, and all claims previously billed with these revenue codes will be recycled on the April 7th, 2015 RA.ulation

If you have questions about the contents of this RA, you may contact Molina Provider Relations at (800) 473-2783 or refer to www.lamedicaid.com.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective April 8, 2015 clinical pre-authorization will be required for Androgenic Agents (excluding oxandrolone), lvacaftor (Kalydeco®), and Roflumilast (Daliresp®). These claims will deny with EOB code 066 (Clinical Pre-Authorization Required). For more information please refer to www.lamedicaid.com.

ATTENTION HOSPITAL PROVIDERS:

It was recently noted that code G0379 (Direct Refer Hospital Observation) was not included in recent changes to claims processing logic for observation services resulting in unintended claim denials. The claims processing logic has been corrected. Claims will systematically be recycled without any action required on behalf of the provider. Providers will see this on the April 7th RA

Providers should also note that the service limit for G0379 is 1(one) unit. The actual number of hours in observation is reported under a separate CPT (Current Procedural Technology) code.

Please contact Molina Provider Relations (800)473-2783 or (225) 924-5040 for questions.

New Healthcare Common Procedure Coding System (HCPCS) Modifiers: XE, XP, XS and XU

Four new HCPCS modifiers have been established to provide greater reporting specificity than modifier -59 on claims with dates of service on or after January 1, 2015. They are:

  • XE - Separate encounter: a service that is distinct because it occurred during a separate encounter
  • XP - Separate practitioner: a service that is distinct because it was performed by a different practitioner
  • XS - Separate structure: a service that is distinct because it was performed on a separate organ / structure
  • XU - Unusual non-overlapping service: the use of a service that is distinct because it does not overlap usual components of the main service

Modifier -59 will remain a valid modifier. Use of the new XE, XP, XS and XU modifiers is currently optional. However, providers may choose to use them to specify more clearly the clinical situations in which modifier -59 is now reported.

These modifiers may be used for clinical situations in which two HCPCS/CPT codes are reported by the same provider on the same date of service and that are currently indicated by appending modifier -59 “Distinct Procedural Service” to a HCPCS/CPT code.

These modifiers should not be used unless the proper criteria for use of the modifier are met. Documentation in the medical record must support the use of any modifier that is used.

Provider use of these modifiers will be monitored for abuse and when appropriate, referred to Program Integrity for detailed review and potential recovery of overpayments.

For questions related to this information as it pertains to Legacy Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.