RA Messages for April 27, 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:
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.
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.
ATTENTION
MENTAL HEALTH CLINIC (MHC) PROVIDERS
A new Medicaid
Provider Manual for Mental Health Clinics is currently available at
www.lamedicaid.com.
ATTENTION
DENTAL PROVIDERS
Medicaid recently
identified a problem that caused duplicate payments of dental procedure
codes when submitted more than once by the provider. This problem
affected only those dental claims which were processed from February 22,
2010, through April 19, 2010. Program changes have been implemented to
correct this problem and all duplicate claims that were processed within
the time period mentioned will be automatically recycled by Medicaid and
appear on a future remittance advice. Please keep in mind that all
claims recycled will consist of recouped payments of these duplicate
claims. Should you have any questions, you may contact Provider
Relations at (225) 924-5040.
RHC/FQHC
PROVIDERS
"Adjunct Services"
Effective with DOS
10-21-07, Louisiana Medicaid reimburses for select adjunct services
(currently CPT codes 99050-99051). RHC/FQHC providers were notified
through remittance advices published in July 2008 to begin submitting
claims to preserve timely filing, but to initially expect denials until
programming was finalized.
Programming is now complete and providers will no longer receive denials
due to the adjunct services not being payable to RHC/FQHCs. Updated
billing instructions can be found on the homepage of www.lamedicaid.com.
Claims with proof of timely filing that previously denied due to the
adjunct services not being reimbursable to RHC/FQHCs will be
systematically adjusted and no action is required by providers.
Providers should continue to monitor future RAs.
ATTENTION
PROVIDERS BILLING TPL CLAIMS
It has come to our
attention that many claims for dates of service January 1, 2010 forward,
involving TPL insurance payments, have paid the full Medicaid allowable
amount in error. The logic allowing these claims to incorrectly overpay
has been corrected, and affected claims will be systematically adjusted
to recoup the overpayments previously made. We apologize for any
inconvenience this may have caused. If you had any of these claims that
were processed incorrectly we will recycle the claims during the month
of May.
ATTENTION
PROFESSIONAL SERVICES ANESTHESIA PROVIDERS
Implementation of Reimbursement Changes to Formula Based
Anesthesia Services
Effective with dates
of service on and after January 22, 2010, the reimbursement for formula
based anesthesia services performed by physicians and CRNAs is 75% of
the 2009 Louisiana Medicare Region 99 allowable for services rendered to
Medicaid recipients ages 16 and older, and 90% of the 2009 Louisiana
Medicare Region 99 allowable for services rendered to Medicaid
recipients under the age of 16. For further details, refer to the Office
of the State Register's website (http://doa.louisiana.gov/osr/) for the
emergency rule published on January 22, 2010. Providers began seeing
these reimbursement changes on the RA of February 2, 2010, and are
responsible for adherence to the policy entitled, "Reimbursement for
Formula Based Anesthesia Services," located on the homepage of
www.lamedicaid.com. The reimbursement change was implemented in a timely
fashion and a systematic adjustment of claims was not necessary.