RA Messages for June 8, 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. 

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.

ATTENTION KIDMED PROVIDERS

POLICY UPDATE: Claims for KIDMED (EPSDT) screening services must be submitted within one year from the date of service. This policy for the timely filing of KIDMED screening claims (electronic and paper) has changed from the previous requirement of submission of KIDMED claims within 60 days from date of service. KIDMED claims that are not received for processing within the 60 day time period will continue to receive the EOB edit 435 as a reminder to the provider that the claims should be submitted within 60 days; however, the claim will not deny for this reason. Providers should strive to continue to submit KIDMED claims within 60 days in order for the claims to be adjudicated, and paid claims to be reflected on the RS-O-07 series of reports. In addition, the periodicity rate utilized in KIDMED monitoring may be affected unfavorably if claims are not routinely submitted for processing within 60 days from date of service. Providers should contact the Provider Relations Unit at (800)473-2783 or (225)924-5040 with questions related to this policy change.

ATTENTION PROFESSIONAL SERVICES PROVIDERS

It has come to our attention that some claims that processed on the RA of May 25,2010, were reimbursed referencing the wrong fee on file as a result of the rate reductions implemented last week for dates of service 8/4/2009 forward. The affected claims are identified as those with Evaluation and Management codes for children 0 through 15 years of age. The programming logic has been updated and the reimbursement of future claims beginning with the RA of 6/1/2010 will not be affected by this error. Claims that reimbursed erroneously on the RA of 5/25/2010 will be systematically adjusted and appear on the RA of 6/8/2010. No action is required by providers.

Please note that the aforementioned claims to be adjusted on the RA of 6/8/2010 will be adjusted again in the near future. This will be done to account for the delayed implementation of rate reductions for children 0 through 15 years of age to 90% of 2009 Region 99 Medicare fees effective for DOS 1/22/2010 forward.

ATTENTION DENTAL PROVIDERS

Medicaid recently identified a problem that caused duplicate payments of dental procedure codes when submitted more than once by the provider. This problem affected only those dental claims which were processed from February 22, 2010, through April 19, 2010. Program changes have been implemented to correct this problem, and all duplicate claims that were processed within the time period mentioned will be automatically recycled by Medicaid and will appear on your June 8th remittance advice. Please keep in mind that all claims recycled will consist of recouped payments of these duplicate claims. Should you have any questions, you may contact Provider Relations at 225-924-5040.

ATTENTION PROVIDERS: IDENTIFYING OIL-SPILL RELATED
ILLNESSES/INJURIES FOR MEDICAID RECIPIENTS

In the effort to track and evaluate all health effects related to the BP Oil Spill, DHH is implementing claims billing indicators to be used to identify services provided to Louisiana Medicaid recipients when treated for an oil spill-related illness or injury. More detailed information concerning the indicators to be used is located on the Louisiana Medicaid website, www.lamedicaid.com, on the home page under the "Oil Spill Related Information" link. Providers should begin immediately using these indicators on claims submitted for Medicaid payment. Please visit the website and begin entering the correct indicator for your claims. This information is critical to state agencies monitoring the health impact of the oil spill.

'ClaimCheck' Denials Related to Modifier-51

Providers who have received ClaimCheck denials for error 934 (Modifier 51 Required-ClaimCheck) and 938 (Modifier 51 Invalid-ClaimCheck) are asked to briefly delay resubmission of these claims to prevent inadvertent additional denials. The necessary updates to the claims processing system that will allow the resubmitted claims to properly process are being addressed and tested. It is anticipated that these updates will be complete in the next few weeks. Providers will be notified when claims for these errors can be resubmitted. Please use the blue ClaimCheck link on the Medicaid website, www.lamedicaid.com, for the most current information on ClaimCheck. For questions related to this matter, please contact Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225) 924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
RE: AUG 4, 2009 RATE REDUCTIONS
SYSTEMATIC ADJUSTMENT OF CLAIMS ADJUDICATED PRIOR TO IMPLEMENTATION

Providers will see adjustments to their weekly RA's for claims with dates of service Aug 4, 2009-Jan 21, 2010 that were adjudicated prior to May 25, 2010. These claims will be systematically adjusted over a period of 16 weeks in numerical order by the original date of adjudication. No action is required by providers. The Adjusted claims for each billing provider will appear on multiple RA's beginning with the RA of June 8, 2010. Claims can be identified as having an ICN beginning with 0149 and 0150. Providers are encouraged to continue to monitor their RA's and the LA Medicaid website at www.lamedicaid.com for updates regarding the rate reductions, updates to the Professional Services Fee Schedule, and a supplement to the fee schedule detailing procedure codes affected by the reductions. Please contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning the rate reductions or adjustments.