RA Messages for June 29, 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. 

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.

ATTENTION REHAB CENTERS, AMBULANCE TRANSPORTATION
KIDMED SCREENING CLINICS, DME, MOBILE X-RAY/RADIATION THERAPY CENTERS
& OPTICAL SUPPLIERS

It has come to our attention that some claims that processed on the RA's of 5/25/10, 6/1/10, 6/8/10 & 6/15/10 were reimbursed referencing the wrong fee on file as a result of the implementation of rate changes for professional services providers. The fees and programming logic have been updated. The reimbursement of future claims will not be affected by this error. Claims that reimbursed erroneously on the RA's previously mentioned will be systematically adjusted in the near future. No action is required by providers. Providers are encouraged to continue to monitor their RA's for these adjustments and the LA Medicaid website (www.lamedicaid.com) for a detailed list of the codes impacted. Please contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning the error and adjustment of claims.

RHC/FQHC PROVIDERS
"Adjunct Services"

Effective with date of service October 21, 2007, Louisiana Medicaid reimburses for select adjunct services (currently CPT codes 99050-99051). RHC/FQHC providers were notified through RA's published in July 2008 to begin submitting claims to preserve timely filing, but to initially expect denials until the programming was complete. RA's published in April 2010 notified providers that the programming was complete. Reimbursement for adjunct services became effective with date of processing 04/19/2010.

Claims submitted timely with a date of processing prior to 04/19/2010 that initially denied due to the adjunct services not being payable will be systematically adjusted on the 06/29/2010 RA. Only the adjunct services with a paid encounter code (T1015) on the same date of service are able to be adjusted. Claims submitted without the required appropriate basic service (T1015 & associated detail lines) and the adjunct code cannot be processed by the department for payment.

Effective with date of processing April 19, 2010 forward, providers that want to pursue payment for adjunct services on a previously paid T1015 claim that was billed initially without the adjunct code can seek reimbursement by voiding the original T1015 claim and resubmitting the T1015 and associated detail lines with the adjunct code as one of those detail lines. If the date of service on the claim is greater than one-year old, the claim must be submitted hard copy with proof of timely filing. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the reimbursement and adjustment of claims for adjunct services.

ATTENTION HOSPITAL PROVIDERS

LA Medicaid now accepts 2-page hard copy outpatient claims for Medicaid ONLY claims (no TPL or Medicare). This change allows for billing a maximum of 44 detail lines with Total Charges entered on page 2. Please review the revised UB-04 billing instructions posted on the LA Medicaid website for information. Providers billing electronically continue to have the ability to bill a maximum of 99 claim lines for outpatient claims. Please contact Provider Relations at (800) 473-2783 or (225) 924-5040 with any questions.