RA Messages for May 25, 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. 

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 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 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.

ASSISTANT SURGEON/ASSISTANT AT SURGERY COVERED PROCEDURES

Effective with date of service May 10, 2010, Louisiana Medicaid has updated the claims processing system related to procedure codes allowed to be billed with either the '80' or 'AS' modifier. This update was part of the preparation for the implementation of ClaimCheck editing which uses the American College of Surgeons as its primary source for determining if an assistant surgeon is clinically valid for a surgical procedure. Some procedures not previously allowed may now be reimbursable--and some procedures that were allowed will no longer be reimbursed to the assistant surgeon or assistant at surgery. The list of covered procedures can be found on the Medicaid website, www.lamedicaid.com, and then using the ClaimCheck icon. Questions concerning this notice may be directed to Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225) 924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
IMPLEMENTATION OF AUGUST 4, 2009 RATE REDUCTIONS

The reimbursement rate reductions for professional services effective with dates of service Aug 4, 2009-Jan 21, 2010, have been implemented. Providers will begin seeing these reductions on the RA of May 25, 2010. Refer to the Office of the State Register's website at http://doa.louisiana.gov/osr/ for published rules detailing these reductions. Providers should monitor the LA Medicaid website, www.lamedicaid.com, for updates to the Professional Services Fee Schedule to occur in the near future. A supplement to the fee schedule will also be posted detailing the procedure codes affected by the reductions.

Claims for dates of service Aug 4, 2009-Jan 22, 2010 that were adjudicated prior to May 25, 2010 are currently being assessed to determine an approach to systematic adjustment. No action is required by providers. Continue to monitor future RAs for details regarding these adjustments. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the implementation of the rate reductions.