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 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.

New Medicaid Requirements for Entering Attending and Referring Providers on Institutional Claims

Effective with dates of service on or after September 1, 2016, Institutional fee-for-service provider claims (Hospital, Hospice, End Stage Renal Disease, Nursing Facility and ICF/DD and Home Health) will deny for issues related to Attending and Referring provider data sent.

Edit 444 will be set for issues related to Attending provider data reported on the UB04/837I claim, and Edits 144 and 090 will be set for issues related to Referring provider data. For more information regarding these changes, please see the detailed notice on the LA Medicaid website (www.lamedicaid.com), titled, "New Medicaid Requirements for Attending and Referring Providers on Institutional Claims," dated May 11, 2016.

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.

New Medicaid Requirements for Enrolling Ordering, Prescribing, and Referring Providers

The Affordable Care Act (ACA) requires physicians or other practitioners who order, prescribe, or refer items or services to Medicaid recipients to enroll in the Louisiana (LA) Medicaid Program, even when they do not submit claims to Medicaid. These requirements are designed to ensure items or services for Medicaid recipients originate from appropriately licensed providers who have not been excluded from Medicare or Medicaid.

LA Medicaid will begin denying fee-for-service claims, effective with dates of service on or after September 1, 2016 when the ordering, prescribing, or referring provider is not enrolled in LA Medicaid. Please see the detailed notice titled, "Requirements for Ordering, Prescribing, and Referring Providers" on the LA Medicaid website (www.lamedicaid.com), dated May 11, 2016 for more information concerning this requirement and billing information.

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.

ATTENTION ALL PROVIDERS
INCORRECT USE OF ICD-9/ICD-10 CODES AND QUALIFIERS
WILL RESULT IN CLAIM DENIALS

During post-monitoring of the implementation of ICD-10 coding for Louisiana Medicaid Fee-for–Service claims, we have discovered that a number of providers are continuing to bill claims using the correct ICD-10 diagnosis code qualifiers but placing ICD-9 codes in the diagnosis fields. During this ‘grace’ period, these claims have continued to pay even though the coding is incorrect. Effective with processing date June 1, 2016, claims that are not billed with correct ICD codes to match the qualifiers provided will be denied. Edits 151 (Claim Contains Mixed ICD Code Sets) and 152 (Invalid ICD Code Set for Claim Dates of Service) will be used to deny these claims.

It is imperative that providers work with their systems vendor and internal staff to ensure that correct diagnosis codes and diagnosis code qualifiers are used in the appropriate positions on claims to prevent unnecessary claim denials.