RA Messages for July 13, 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 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.

ATTENTION HOSPITAL PROVIDERS SUBMITTING PA REQUEST FOR VAGUS
NERVE STIMULATORS (VNS)

Effective June 14, 2010, it is no longer necessary for hospitals to submit the Form PA-01 for the Vagus Nerve Stimulator (VNS) as part of the multi-disciplinary team's packet. Hospitals may submit the Form PA-01 for the device directly to Molina's Prior Authorization Unit. Authorization of the device continues to be dependent upon approval of the surgeon to perform the procedure. If the surgeon's request is approved, the hospital will then be given a PA number for the VNS. To be reimbursed for the device, hospitals shall submit HCPCS procedure code C1767, VNS generator, and C1778, VNS leads, to Molina on a CMS 1500 claim form with the words DME written in red on the top of the form and the PA number written in Item 23 or through the electronic claims submission.

ATTENTION PROFESSIONAL SERVICES AND KIDMED PROVIDERS
IMPLEMENTATION OF JANUARY 2010 RATE REDUCTIONS

The reimbursement rate reductions for professional services effective with date of service January 22, 2010, have been implemented. Providers will begin seeing these reductions on the RA of July 20, 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. Continue to monitor future RAs for details regarding when the recycle of these claims will take place. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the implementation of the rate reductions.