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: HOSPICE PROVIDERS
Service Intensity Add-On Reimbursement Rates Effective January 1, 2016
CMS has implemented a new reimbursement rate for more intensive services provided by registered nurses (RNs) or social workers in the final seven days of a hospice patient’s life.
Effective for dates of service on and after January 1, 2016, a service intensity add-on (SIA) payment will be reimbursable for a visit by an RN or a social worker, when provided during routine home care in the last seven days of a patient’s life. The SIA payment is in addition to the routine home care rate.
The fee schedule has been updated with the current rates according to each metropolitan service area (MSA) for SIA services and the required hospital revenue code (HR659). The claim for SIA services must be billed in units. Each unit is equal to 15 minutes. The maximum number of reimbursable units per day is 16 units. The seven day maximum number of reimbursable units is 112 units. All claims must be submitted with documentation demonstrating the necessity of the services provided. Documentation submitted should reflect the arrival and departure time of the professional providing the services.
Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.
Updates to Bayou Health-related systems and claims processing changes are plan specific and are the responsibility of each health plan. For questions regarding Bayou Health updates, please contact the appropriate health plan.
Attention Providers of CLIA Waived Tests
CMS mandated Clinical Laboratory Improvement Amendments (CLIA) claim edits are applied to all fee for service claims for laboratory services. Those claims that do not meet the required criteria will deny. Providers with waiver or provider-performed microscopy (PPM) certificate types may be paid only for those waiver and/or PPM codes approved for their certification types. Providers with these certification types are to add the 'QW' modifier to the procedure code for all applicable CLIA waived or PPM tests they submit for reimbursement.
Please note that the fee for service claims processing system has been updated to assure correct processing of claims for laboratory services.
Effective for claims processed on or after May 10, 2016, the following Current Procedural Terminology (CPT) codes will require a “QW” modifier to be submitted.
| 82040 |
82043 |
82310 |
82330 |
83721 |
84155 |
84550 |
85576 |
| 86780 |
87389 |
87502 |
87651 |
87806 |
87905 |
89321 |
|
Additional information can be found in the Professional Services Provider Manual, please refer to Appendix A.
For questions related to this information as it pertains to fee for service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.
Updates to Bayou Health-related systems and claims processing changes are plan specific and are the responsibility of each health plan. For questions regarding Bayou Health updates, please contact the appropriate health plan.
Attention Fee for Service (FFS) Louisiana Medicaid Providers:
Effective May 10, 2016, the Louisiana Medicaid Pharmacy Program in collaboration with the Louisiana Medicaid Drug Utilization Review (DUR) Board has established Point of Sale (POS) edits on Allergen Extracts. Please refer to www.lamedicaid.com for specifics.
ATTENTION SCHOOL BOARDS/EARLY INTERVENTION CENTERS/LEAs
Recent changes were made in the Fee-For-Service Medicaid claims processing system for procedure codes 92507 and 92508. National standards require these codes to be billed ‘per visit’ rather than in ‘multiple units’. When these changes were recently implemented for professional claims, they were also applied to EPSDT Health Services claims in error. Affected EPSDT HS claims that were cut back in error are being recycled on the May 17, 2016 RA to correct the payment.
This change will impact your claims, but it will be effective for claims with dates of service July 1, 2016 forward. In order to prevent incorrect claim payments or denials, please make the necessary changes in your billing systems and procedures to ensure that you are billing claims with dates of service July 1, 2016 forward for codes 92507 and 92508 with 1 unit (representing a visit) which will be paid at a flat fee.