RA Messages for July 22, 2008
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.
NPI - ALL PROVIDERS
On Friday, July 18th, DHH reinstated the
requirement to have a valid NPI on each claim transaction within a
submitted electronic claims file. With the exception of atypical
providers, beginning July 18th a Medicaid 7-digit legacy provider id
number can not be used in the electronic 837 Billing and Attending loops
of transactions (at this time, the referring provider loop should
contain the correct NPI and/or Medicaid 7-digit legacy provider id of
the referring provider).
Electronic claims files (837) received on or after
July 18th will no longer be rejected if the file contains a claim
transaction with a NPI error. The file will be processed and a report
will be produced for the EDI submitter of the claims to use to identify
the denied claim transactions. These reports will be available only to
EDI submitters and on www.lamedicaid.com, in the future. Submitters must
register on the website using their submitter ID number to use this
application.
If you have one NPI for one
7-digit Medicaid id number, please ensure that you are electronically
billing with that NPI. If you have one 7-digit Medicaid id number but
have registered with NPPES and received an individual NPI and an
organizational NPI, we need both numbers to process your claims. Please
review information on our website concerning reporting the individual
and organization NPI. Please note: paper claims require the 7-digit
Medicaid provider number in the appropriate fields on the claim forms.
PROFESSIONAL SERVICES AND RHC/FQHC
PROVIDERS
ADJUNCT SERVICES
Effective with dos 10-21-07, Louisiana Medicaid
reimburses for select adjunct services (currently CPT codes
99050-99051). Providers are responsible for adherence to the 'adjunct
services policy,' which is located on www.lamedicaid.com under 'New
Medicaid information' as well as in the 'Louisiana provider update.'
professional services providers may now submit claims for these
services.
rhc/fqhc providers may begin submitting claims to
preserve timely filing, but should initially expect denials until
programming is finished. RHC/FQHC claims that deny due to this issue
will be systematically adjusted once programming is complete, and
providers should monitor future RA's for further information.
ATTENTION PROFESSIONAL SERVICES
PROVIDER
2008 REIMBURSEMENT RATE CHANGES
Effective with dos January 1,
2008, reimbursement rates for select physician services were updated.
Not all procedure codes are impacted. In brief, the same methodology
used for the 2007 professional services rate changes was updated to
reflect percentages of the 2008 Medicare region 99 rates. Refer to the
home page of the Louisiana Medicaid website, www.lamedicaid.com, link
'2007 & 2008 professional services rate changes' for more details.
Affected claims paid at the previous rate will be systematically
adjusted. Due to the large claims volume, the adjustments will occur
over several weeks in numerical order by billing provider number,
beginning with the RA of July 22, 2008. These 2008 adjustments can be
identified as having an ICN beginning with 8186 or 8187. Please monitor
your RA's to determine which date your claims were recycled. Providers
may contact Unisys provider relations at 800-473-2783 or 225-924-5040 if
there are further questions.
DELAY OF DENIAL EDITS FOR NDC ON
PHYSICIAN ADMINISTERED DRUGS
Initially, with date of processing July 1, 2008,
claims submitted without the required, accurate NDC information for
Physician Administered Drugs were to deny. Currently, providers are
receiving educational edits for claims that do not contain this
information. The department has received concerns and issues from large
providers experiencing difficulty in preparing their systems to submit
these claims with the required information. As a result, the decision
has been to delay the implementation of denials for the NDC educational
edits until further notice. Please monitor the website and RA messages
for updated info.
BILLING CLARIFICATION FOR LT-PCS OR HOSPICE
Receipt of any form of long
term-personal care services precludes eligibility to receive hospice.
For example, if a person receiving hospice services wishes to receive
LT-PCS, Hospice must be discontinued. Conversely, if a LT-PCS client
wishes to receive hospice, the LT-PCS must be discontinued. Providers
who are billing for both services concurrently are doing so against
Medicaid policy and must reconcile their billing accordingly.