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 PROVIDERS:

PAYMENT ERROR RATE MEASUREMENT (PERM) 2014 PROVIDER EDUCATION WEBINARS

The Centers for Medicare & Medicaid Services (CMS) will be hosting PERM Provider Education Conference Calls/Webinars this summer, to provide interactive sessions for providers of Medicaid and Children's Health Insurance Program (CHIP) services. Providers will be informed about PERM updates, trends and responsibilities. There will be opportunities to ask questions and provide feedback to CMS and your state representatives.

For Webinar details, refer to the March/April, 2014 Provider Update Article, located in the Provider portal at www.lamedicaid.com.

Attention Intermediate Care Facility Providers

Effective April 1, 2014 the Provider Fee for Intermediate Care Facilities (ICF) days will increase from $14.30 to $16.15 as allowed by Louisiana Revised Statute 46:2625. Future Quarterly Fee Reports issued by the Department will reflect this change. Medicaid is awaiting CMS approval for the rate increase. Once this increase is approved DHH will recycle claims to pay you the increased rate associated with the fee increase.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective May 30, 2014, diagnosis codes will be required on pharmacy claims for select specialty drugs. Please refer to www.lamedicaid.com for the complete list with appropriate diagnosis codes.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective May 30, 2014, pharmacy claims for Victrelis® (boceprevir), Incivek® (telaprevir), Sovaldi® (sofosbuvir), and Olysio® (simeprevir) will have therapeutic duplication and early refill edits applied. Please refer to www.lamedicaid.com for specifics.

ATTENTION HOSPITAL PROVIDER OF OUTPATIENT REHABILITATION SERVICES:

We recently learned that some outpatient hospital rehabilitation services billed for children under 3 years old are paying at an incorrect rate. This only included a few isolated codes. This problem has been identified, corrected, and affected claims are systematically adjusted on the 5/27/14 RA. Please reconcile these adjustments appearing on the RA, and if you have other affected claims that were not identified in this systematic process, please submit an adjustment for processing. We apologize for any inconvenience.

AFFORDABLE CARE ACT ENHANCED REIMBURSEMENT RECYCLES - Medicare Crossover Claims

Primary care service providers with an attestation on file for enhanced reimbursement through the Affordable Care Act had some of their Medicare crossover claims paid without making use of the specific ACA pricing. This only affected claims processed and paid prior to the 4/29/14 checkwrite. It was at this time that the claims system was updated to properly pay these claims using the ACA pricing for specific procedures. Only paid claims eligible for enhanced reimbursement, which include dates of service in calendar years 2013 and 2014, will be recycled and reflected on the 6/3 check-write.

For further information regarding the ACA enhanced reimbursement, including applicable procedure codes, please visit http://www.lamedicaid.com/ACA/ACA.htm.

ATTENTION ALL PROVIDERS USING THE CMS 1500 02/12 FORM FOR CLAIMS SUBMISSION - DATA ENTERED IN FIELD 22

Professional providers were recently notified of the transition from the proprietary 213 Adjustment/Void Form to the CMS-1500 Form for adjusting and voiding claims. Field 22 on the CMS 1500 (02/12) is the location where providers should enter adjustment/void information. As this transition has occurred, we have found that some providers use this field for their internal record keeping by entering the ICN of a previous claim as a reference. In the past, Molina did not key data from Field 22, so if providers entered internal data in this field, it did not cause problems. Effective with claims submitted on or after June 6, 2014 (regardless of date of service), claims submitted with data in Field 22 that is incomplete adjustment/void information will deny with error code �013-ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID ICN'. Please discontinue using Field 22 on claims submissions unless the submission is an adjustment or void.