RA Messages for April 20, 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:
CERTIFIED NURSE MIDWIVES AND OB PROVIDERS
BILLING INFORMATION UPDATE: FIRST ASSISTANT AT SURGERY
Effective with date of
service May 1, 2010, Certified Nurse Midwives (CNM) who perform as the
'first assistant surgery' are to use the "AS" modifier to identify these
services. This billing update for Certified Nurse Midwives is to provide
consistency in billing for non-physician providers who perform as the
first assistant in surgery. There is no change in reimbursement
methodology for CNM's. Questions concerning this update may be directed
to Unisys Provider Relations at (800) 473-2783 or (225) 924-5040.
TAKE CHARGE
FAMILY PLANNING WAIVER - REIMBURSEMENT RATE
CUT FOR ALL FPW SERVICES
Due to budgetary
shortfalls, DHH has implemented a 5% reimbursement rate cut for ALL FPW
services. This rate cut has been implemented with an effective date of
1/22/2010.
ATTENTION:
IMMUNIZATION PAY-FOR-PERFORMANCE ENROLLED PROVIDERS
The Department of
Health and Hospitals has determined that to avoid a budget deficit, a
change in the Immunization Pay-For-Performance Initiative (P4P) is
necessary. Effective with P4P payments for April 2010 and thereafter,
the initial benchmark measurement to receive a payment will be that 60%
to 74% of the recipients linked to the participating CommunityCARE PCP
must be up to date by age 24 months to be eligible to receive an
incentive payment. No changes are being made to the second or third
level benchmark or payments. Detailed information on the P4P incentive
payment initiative can be found on the www.lamedicaid.com website,
following the link for Pay-For-Performance. For details regarding the
Emergency Rule associated with this change, please go to the Emergency
Rule section of the Louisiana Register at the Office of the State
Register's website (http://doa.louisiana.gov/osr/). Contact Unisys
Provider Relations at (800) 473-2783 or (225) 924-5040 with any
questions.
ATTENTION
OUTPATIENT HOSPITALS AND FREE-STANDING ESRD FACILITIES
H1N1 INFLUENZA ADMINISTRATION
Effective with date of
service October 1, 2009, Revenue Code 771 (Vaccine Administration) is
payable to outpatient hospitals and free-standing ESRD facilities, but
only if billed with CPT code 90470 (H1N1 Immunization Administration).
As the H1N1 vaccine is being supplied at no charge by the Office of
Public Health (OPH) and to only those providers that previously
registered with OPH, Medicaid will reimburse providers only for the
administration of the vaccine. Detailed policy and a fee schedule
specific to the H1N1 influenza vaccine administered by outpatient
hospital and ESRD providers has been added to the 'H1N1 Influenza
Information' link on the homepage of www.lamedicaid.com. Claims
previously denied due to delay in implementation will be systematically
adjusted and no action is required by providers. Providers should
contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040
with billing or policy questions. Questions related to the H1N1 vaccine
including availability should be directed to the OPH Immunization
Program at (504) 838-5300.
IMPORTANT
NOTICE TO ALL MEDICAID HOSPICE PROVIDERS
The
Department of Health and Hospitals will partner with Automated Health
Systems (AHS) to administer the Medicaid Hospice Program. Effective May
1, 2010, Hospice providers are to appropriately submit all hospice
related forms and prior authorization requests to:
Automated Health Systems
10101 Siegen Lane
Baton Rouge, LA 70810
Attention: Hospice Manager
Fax: (225) 757-4360
ATTENTION
PROFESSIONAL SERVICES PROVIDERS: CLAIMCHECK WEBINARS
The implementation of
McKesson ClaimCheck editing for professional services is anticipated to
become effective with the processing date May 17, 2010. Educational
webinars concerning this implementation will be held April 27-29, 2010.
Providers should visit the LA Medicaid website, www.lamedicaid.com, and
click on the blue 'ClaimCheck' button for further information and to
register for one of the webinars. Affected providers are strongly
encouraged to attend.
Questions concerning this notice may be directed to Unisys Provider
Relations at (800) 473-2783 or (225) 924-5040.