RA Messages for July 6, 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.
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.
ATTENTION
AUDIOLOGY SERVICE PROVIDERS
Programming logic has
been updated for audiology procedure codes 92540, 92550, and 92570,
effective for date of service January 1, 2010 forward. Claims that
previously denied with error code 210 "PROVIDER NOT CERTIFIED FOR THIS
PROCEDURE" will be systematically adjusted and will appear on the RA of
June 29, 2010. No action is required by providers.
ATTENTION ALL
PROVIDERS WHO USE THE SPEND-DOWN
MEDICALLY NEEDY NOTICE (110-MNP)
The fillable form
titled "Provider Request for Spend-Down Medically Needy Notice" has been
revised with a new fax number. This form is used to request "Spend-Down
Medically Needy Notices" (110MNP) for one or multiple Medicaid
recipients. If you have any questions, please call Lesli Boudreaux,
Medicaid Program Manager, at 225-219-1783. The form can be found on the
Forms page of the Medicaid Provider website at www.lamedicaid.com in the
section titled "Online Forms or Files."
ATTENTION
DURABLE MEDICAL EQUIPMENT (DME) AND PHARMACIES
PROVIDING DME SERVICES
It has come to our
attention that some discrepancies exist with the reimbursement
methodology for providers who have delivered DME services. As a result
of the budget shortfall in 2000, DHH implemented an option under the
federal Medicaid rules that allow the agency to compare Medicaid's
allowable to Medicare's reimbursement. In these instances where Medicare
reimburses more than Medicaid's allowable, Medicaid is not responsible
for the coinsurance and/or deductible that would have been paid for
these individuals prior to 2000. This methodology was not implemented
across all providers of DME services. Effective with date of processing
August 1, 2010, DHH has corrected the payment methodology to cost
compare the claims for all providers of DME services.