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.

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 DESCRIPTIONS RATE
A6021 COLLAGEN DRESSING, STERILE, PAD SIZE 16 IN. LESS, EACH $15.81
A6022 COLLAGEN DRESSING, STERILE, PAD SIZE MORE THANK 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.

ATTENTION NURSING HOME ADMINISTRATIORS

As part of the budget reduction measures by the Department of Health and Hospitals, Medicaid will no longer pay co-insurance on therapy services (physical therapy, occupational therapy and speech/language therapy) on Medicare/Medicaid Cross-over claims effective with Date of Service July 1, 2012. Claims billed on or after this date of service will '0' pay with edit 384 -NOT COVERED FOR NURSING HOME RESIDENT. If you have questions please contact Denis Beard at 225-342-6116.

ATTENTION BAYOU HEALTH PROVIDERS

Due to a processing error during the month of March 2012,649 GSA A BAYOU HEALTH members who originally linked to Health Plans for February reverted to legacy Medicaid for the month of March only. A review has been conducted and all 649 members were relinked to their previous Health Plans effective April 1st. Please verify member linkage on eMEVS if you are getting denials for March 2012 dates of service. Providers should contact the Molina Provider Relations Unit at (800) 473-2783 or (225) 924-5040 with billing or policy questions regarding services provided to these members during the month of March.

EHR INCENTIVE PAYMENT PROGRAM - UPDATE

Since January 2011, nearly 1,300 eligible medical professionals and hospitals have received more than $120 million in incentive payments through participation in Louisiana's Medicaid Electronic Health Records (EHR) Incentive Payment Program. The EHR Incentive Payment Program is a 100% federally funded initiative that promotes the adoption and meaningful use of certified EHR technology through the provision of incentive payments to eligible professionals and hospitals. Eligible professionals can receive a maximum of $63,750 in incentive payments over a six-year period, and in 2011, the average payment to Louisiana's participating hospitals was $1.1 million.