RA Messages for May 18, 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 PROVIDERS

The FDA has determined that the following active Exocrine Pancreatic Insufficiency NDCs are unapproved new drugs within the meaning of section 201(p) of the Federal Food, Drug and Cosmetic Act, subject to enforcement action, and cannot be marketed without appropriate FDA approval. According to the FDA, these products do not have approved applications; therefore, CMS has determined that the NDCs do not meet the definition of a covered outpatient drug as defined in Section 1927(k) of the Social Security Act and are subsequently no longer eligible for inclusion in the rebate program. These drugs will be non-payable by the Louisiana Medicaid Pharmacy Benefits Management Unit.
 
 NDC                     PRODUCT NAME
 
00032-1205         CREON5 CAPSULES
00032-1210         CREON10 CAPSULES
00032-1220         CREON20 CAPSULES
00091-4175         KUTRASE CAPSULES RX
10267-2737         PANCRELIPASE 8,000 TABLETS
39822-9045         PANCRLIPASE 4,500
39822-9100         PANCRELIPASE 10,000
39822-9160         PANCRELIPASE 16,000
39822-9200         PANCRELIPASE 20,000
58177-0028         PANGESTYME MT 16 CAPSULES
58177-0029         PANGESTYME CN 10 (PANCRELIPASE) DELAYED RELEASE CAP
58177-0030         PANGESTYME CN 20 (PANCRELIPASE) DELAYED RELEASE CAP
58177-0031         PANGESTYME EC CAPSULES
58177-0048         PANGESTYME UL 12 CAPSULES
58177-0049         PANGESTYME UL 18 CAPSULES
58177-0050         PANGESTYME UL 20 CAPSULES
58177-0416         PLARETASE
58914-0002         ULTRASE MT 12
58914-0004         ULTRASE MT 20
58914-0018         ULTRASE MT 18
58914-0045         ULTRASE MS 4
58914-0111         VIOKASE
58914-0115         VIOKASE 8OZ POWDER
58914-0116         VIOKASE 16000
59767-0001         PANCRECARB MS-8
59767-0002         PANCRECARB MS-4
59767-0003         PANCRECARB MS-16

PHARMACY PROVIDERS PLEASE NOTE

On May 11th, CMS data available for individual NDC's was upgraded and a new edit message 149 - DESI INEFFECTIVE-NOT PAYABLE was implemented. This edit will deny payment for the claims with NCPDP Error Code 70 - Product/Service Not Covered.

ATTENTION COMMUNITYCARE PROVIDERS

Effective with date of service June 1, 2010, the Department will no longer pay CommunityCARE PCP management fees (procedure code CC001) for linked enrollees after the month of the enrollee's death. Recent audit findings have revealed that on occasion deceased enrollees have remained active in CommunityCARE prior to Medicaid being informed of their death. In the future, payments after the month of death will be automatically calculated and recouped, regardless of the current status of the PCP's CommunityCARE participation. Management fee recoupments will be identified on the Remittance Advice by error edit 364 - RECIPIENT DECEASED.

ATTENTION ALL MEDICAID PROVIDERSS
DELAYED IMPLEMENTATION & CLAIM ADJUSTMENTS FOR RATE REDUCTIONS

The implementation of reimbursement rate reductions for the following programs has occurred, but was initially delayed: (1) Anesthesia Services effective with DOS August 4, 2009; (2) ASC (Non-Hospital) effective with DOS February 4, 2010; and (3) Lab & Radiology services effective with DOS January 22, 2010. Previously paid claims will be systematically adjusted in the very near future with no action required by providers. Continue to monitor future RA's for these adjustments.

The implementation of reimbursement rate reductions for the following programs has been delayed and will occur in the very near future: (1) Professional Services-Physician Services effective with DOS August 4, 2009; (2) Professional Services-Physician Services effective with DOS January 22, 2010; and (3) Free Standing ESRD Facilities effective with DOS January 22, 2010. Providers should continue to monitor RA's and www.lamedicaid.com for status updates. For details regarding what services are affected by these reductions, please refer to the emergency rules on the Office of the State Register's website (http://doa.louisiana.gov/osr/). Providers should continue to contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the implementation of the rate reductions.

ATTENTION KIDMED PROVIDERS

With the implementation of ClaimCheck on DATE OF PROCESSING May 17, 2010, a change is being made that may directly impact you. In circumstances where a child has a KIDMED screening, a suspected condition is identified, and the child must be referred in-house for a 'sick' visit on the same date of service, the 'sick' visit procedure code 99211 or 99212 MUST be accompanied by the 25 modifier. Following ClaimCheck implementation, absence of the 25 modifier will cause your claim to deny. Please take the necessary steps within your system or procedures to ensure that the 25 modifier can be appropriately placed on these claims.

ATTENTION INDEPENDENT LABORATORY PROVIDERS
SPECIMEN COLLECTION POLICY

With the implementation of ClaimCheck claims editing planned for date of processing May 17, 2010, specimen collection (routine venipuncture) will be considered integral/incidental to the laboratory procedure(s) performed on the same date and not separately reimbursable. This policy update provides consistency in Medicaid policy among provider types. Questions concerning this notice may be directed to Unisys Provider Relations at (800) 473-2783 or (225) 924-5040.

ATTENTION ALL PROVIDERS

Effective May 1, 2010, the Department of Health and Hospitals (DHH) will partner with Automated Health Systems (AHS) as the CommunityCARE/KIDMED program administrator. AHS will assume all of the CommunityCARE/KIDMED program administrator's duties, including performing provider certifications and enrollment for both programs, and will resume on-site provider certification visits and monitoring functions, as well. Several improvements are in the works to enhance the CommunityCARE/KIDMED experience for the provider and the Medicaid enrollee, including changes to websites. AHS and DHH are working to ensure a smooth transition; no action is required on your part. The new CommunityCARE/KIDMED mailing address is Automated Health Systems, 10101 Siegen Lane, Baton Rouge, LA 70810, Attn: CommunityCARE/KIDMED Programs; FAX: 225-757-8466. All telephone numbers will remain the same.

ATTENTION LAB & RADIOLOGY (NON-HOSPITAL) PROVIDERS
SYSTEMATIC CLAIMS ADJUSTMENT FOR AUG 4, 2009 RATE REDUCTIONS

DHH has identified claims impacted by the lab & radiology rate changes effective Aug 4, 2009, that erroneously denied when the claims adjustment occurred on the RA of either January 26, 2010 (Claim ICN range of 0010222000100-0010283739200), or February 2, 2010 (Claim ICN range of 0017222000100-0017272663000). The denied adjustment claims are denoted on these RA's and will be systematically adjusted again to appear on the RA of May 4, 2010. No action is necessary by providers.

ATTENTION ALL PROVIDERS

Effective May 1, 2010, Molina Healthcare purchased the Health Information Management Division of UNISYS Corporation. With this acquisition, the Louisiana Medicaid fiscal intermediary transitions from UNISYS to Molina Medicaid Solutions. This transition will be seamless to providers, who will continue to interact with the same staff at the same contact telephone numbers and addresses as in the past. Please visit the LA Medicaid website, www.lamedicaid.com, for more information and a link to the Molina Healthcare website.

ATTENTION ANESTHESIA PROVIDERS

Louisiana Medicaid has identified an issue where pregnancy-related anesthesia claims deny when a physician/anesthesiologist initiates the anesthesia for a procedure (initiation ONLY) and the CRNA monitors the anesthesia throughout the procedure (monitoring ONLY). In these cases, when billed with appropriate modifiers, both claims should process correctly. We found that one of the claims (either doctor or CRNA) paid and the other claim denied for edit 748 (only 1 delivery allowed in 6 month span). The logic has been corrected and related denied claims were recycled on the RA of May 11, 2010. Some of the recycled claims will deny again for a correct edit. Providers must work these claims and resubmit them with corrections for payment if appropriate. We apologize for any inconvenience caused by this issue.