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.

Psychiatric Services: 2013 CPT Changes

In association with the 2013 HCPCS update, Louisiana Medicaid fee for service has established policy related to reimbursement of the new psychiatric diagnostic and psychotherapy procedure codes. Effective with dates of service May 21, 2013 and forward, it is the intent of Louisiana Medicaid to only reimburse providers for these services (currently CPT codes 90791-92 and 90832-90840) when there are face-to-face services where the patient is present and must be clearly documented in the patient record. This policy supersedes recommendations or changes in procedure code descriptions in the Current Procedural Terminology manual for these services. For questions related to this information, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

For policy related to Louisiana Behavioral Health Partnership (LBHP), consult the LBHP Services Manuel at http://new.dhh.louisiana.gov/index.cfm/page/538.

Update to 'ClaimCheck' Product Editing

McKesson's 'ClaimCheck' product is routinely updated by McKesson Corporation based on changes made to the resources used, such as Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding guidelines, the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule database, National Correct Coding Initiative (NCCI) edits, and/or provider specialty society updates. The 'ClaimCheck' product's procedure code edits are guided by these widely accepted industry standards.

The edit changes will affect claims processed begiooiog with tbe remittance advice of May 21, 2013 forward. Providers may notice some differences in claims editing that includes pre/post� op days, incidental, mutually exclusive, rebundling, add-on and multiple surgery reductions. Providers should expect that some claims will continue to deny for the same error, but when applicable, claims may now pay or deny for a different reason.

With this update, Louisiana Medicaid (claims that process through the Molina claims processing system) also implemented the 2013 quarter one NCCI edits; however, the code pairs specific to preventive services and immunization administration have been deactivated based CMS approval. Doing so aligns with our intent and expectations that appropriate immunizations are to be given at the time of the preventive visit to avoid missed opportunities in both preventive care and immunizations.

ATTENTION SUBMITTERS/PROVIDERS OF ELECTRONIC CLAIMS

The deadline for receiving 2013 Annual EDI Certification Forms has passed. If you have not submitted a 2013 Certification form for your submitter number (beginning with 450), immediate action is required. Failure to submit the required form by May 31, 2013 will result in deactivation of the submitter number. If a number is deactivated, the Certification form will have to be received in the Molina EDI Department hardcopy (no faxes or email attachments accepted) before the number is reactivated. This will result in a delay in payment for your providers. If we already received your 2013 form, you or your vendor would have received an email from us confirming receipt. If you have any questions, call the EDI Department at (225) 216-6303.

Attention Professional Services Providers:

Effective with dates of service January 1, 2013 and forward, the following Current Procedural Terminology (CPT) Codes are now payable on the Professional Services Fee Schedule: 81265, 81267, 81380, and 81382. The next fee schedule update should reflect those changes. Providers should resubmit claims as appropriate. For questions related to this information, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Professional Services Providers:

The Department will be conducting random audits to monitor billing practices relative to delivery/postpartum care. Louisiana Medicaid Fee-for-Service reimbursement policy for postpartum visits requires that providers shall not bill global Current Procedural Terminology (CPT) Codes covering the delivery and the postpartum visit until after the postpartum visit has been completed. Payments for services found to be inappropriately billed may be recouped. For questions related to this information, please contact Molina Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Pharmacists and Prescribing Providers:

Pharmacy claims for somatropin for shared health plans or legacy recipients require a valid diagnosis code effective May 28, 2013. Claims submitted without an appropriate diagnosis code will deny with EOB 575. See http://www.lamedicaid.com/