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. 

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 HOSPITAL PROVIDERS

Effective for dates of service July 1, 2012, and thereafter; Louisiana Medicaid is mandated to meet the requirements of 42 CFR Part 447, Subpart A, and sections 1902(a)(4), 1902(a)(6), and 1903 with respect to non-payment for Provider Preventable Conditions (PPC's) including Health Care Acquired Conditions (HCAC's). Please refer to www.lamedicaid.com for the detailed policy and billing instructions. The guidance applies to fee-for-service claims including the shared savings Bayou Health Plans. The Prepaid Bayou Health Plans are required to implement their own procedures for non-payment for the same events when applicable to their enrollees. Providers should contact the plans to obtain additional information.

NOTICE TO ALL PHYSICIANS PROVIDERS

The Office of Population Affairs (OPA) has updated the Sterilization consent form. The New form is available on their website at http://opa.osophs.dhhs.gov/pubs/publications.html. You may also download a fillable PDF version from the Louisiana Medicaid Website at http://www.lamedicaid.com/provweb1/Forms/Sterilization_Consent.pdf.

Providers should start utilizing the current form effective immediately. For dates of service prior to August 1, 2012 providers may submit the previous version of the Sterilization Consent form that has already been signed by the recipient. Beginning with dates of service August 1, 2012 and beyond, Health Plans and Molina will only accept the Consent form with the expiration date of December 31, 2012.

Molina shall only accept the Consent form with the expiration date of December 31, 2012 beginning with dates of Service August 1, 2012.

TO ALL DME PROVIDERS

Effective with PA requests received July 1, 2012 providers will no longer use HCPC A6020, Collagen Wound Based Dressing. This code has been discontinued and replaced with more descriptive codes, A6021, A6022, A6023 and A6024. Reimbursement for the replacement codes will be based on Medicaid's current payment methodology, and will no longer be manually priced. See chart below for description and rates:

PROC. CODE

 

DESCRIPTION

RATE

A6021

COLLAGEN DRESSING, STERILE, PAD SIZE 16 IN. OR LESS, EACH                                

$15.81

A6022

COLLAGEN DRESSING, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO

48 SQ. IN., EACH                         

$15.81

A6023

COLLAGEN DRESSING, STERILE, PAD SIZE MORE  THAN 48 SQ. IN., EACH                     

$143.09

A6024

COLLAGEN DRESSING WOUND FILLER, STERILE, PER 6 INCHES                                   

$4.66

ATTENTION HOSPITAL PROVIDERS

As claims processing changes were made for the implementation of the Bayou Health Program, the system logic that allowed hospital providers to perform and be paid for RUM procedures done on an emergent basis and without prior authorization was interrupted. These claims began denying with edit 191 (PA required). The logic to by-pass an authorization requirement in these emergent cases was reinstated on June 18, 2012. The recycle of procedure codes 74176, 74177and 74178 occurred on RAs in June, and the recycle of the remaining claims denied in error appears on the 7/3/12 RA. Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 should you have questions concerning this corrective action.

ATTENTION OPTHALMOLOGISTS/OPTOMETRISTS/OPTICAL SUPPLIERS - BAYOU HEALTH SHARED PLAN CLAIMS CONCERNS:

When providing vision/eyewear services to members of a Bayou Health Shared Plan, claims for the vision exam and other medical services provided by an ophthalmologist, optometrist, or optician must be submitted to the patient's Shared Plan for processing. Claims for eyewear should continue to be billed and submitted directly to Molina. Some claims for eyewear were denied in error. Logic changes occurred on June 18, 2012 to allow eyewear claims to process correctly when submitted directly to Molina for consideration. A recycle of the claims denied in error appears on the 7/3/12 RA. Eyewear claims that were initially submitted through the Shared Plan will deny again with edit 313 (Submit claim to FI not BYU), and providers receiving this edit must submit the eyewear claims directly to Molina for processing. Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 should you have questions concerning this corrective action.

ATTENTION PROVIDERS OF EPSDT SCREENING SERVICES

In the initial notice informing providers of the termination of the KIDMED Program, a statement implied that the 'EP' modifier should be used on all screening procedures. Follow-up information also contains an error in the instructions for the use of this modifier. In order to clarify this information, going forward, the 'EP' modifier should continue to be used as it has always been used. Append the 'EP' modifier to: (1) Claims submitted for the vision screening code 99173; and (2) RHC/FQHC encounter code T1015 when billing screenings. DO NOT use the 'EP' modifier on any other screening services. Other modifiers used in the past for billing screening services should continue to be used when appropriate. Please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040 should you have questions concerning this corrective action.