RA Messages for July 27, 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 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.

ATTENTION ALL PROVIDERS

Louisiana Medicaid enrolled providers are reminded to update their Provider Locator Tool contact information through the LA Medicaid website at www.lamedicaid.com. Please refer to the link titled 'Provider Locator Tool Fact Sheet' for instructions on updating your existing contact information and indicating whether you are 'Accepting New Medicaid Patients'. This information will be viewable to recipients attempting to locate a Medicaid provider.

ATTENTION ALL DURABLE MEDICAL EQUIPMENT PROVIDERS (DME)

Medicaid has made the following codes payable effective January 1, 2010. Please use these procedure code(s) when requesting prior authorization.

A4336 Incontinence Supply, Urethral Insert
A4456 Adhesive Remover, Wipes, Any Type
A4466 Garment, Belt, Sleeve or Other Cover
E1036(RR) Multi-Positional Patient Transfer
E0433 Portable Liquid Oxy System, Rental
K0739, K0739(RP) Repair for DME Labor ; Replace E1340, E1340RP
K0740 Repair or Non routine Service for Oxy
L2861 Addition to Lower Extremity Joint
L3891 Addition to Upper Extremity Joint
L8031 Breast Prost., Silicone or Equal
L8032 Nipple Prost., Reusable
L8627 Cochlear Implant, Ext Speech
L8628 Cochlear Implant, Ext Controller
L8629 Transmitting Coil and Cable, Integra
L8692 Auditory Osseointegrated Device, Ext

Please discontinue using the miscellaneous procedure code(s) (E1399)
when requesting prior authorization. The payment methodology for the new
codes remains the same as paid under E1399.

ATTENTION PROVIDERS

In April 2008, new rules were established noting that DHH shall not prevent a provider from pursuing a liable third party for payment in excess of the Medicaid paid amount. If a provider wishes to pursue the difference once he/she has received Medicaid payment, the provider shall submit written notification to Medicaid Recovery within 365 days of the accident or incident for which the third party is or may be liable. In an effort to simplify this reporting process, we are pleased to announce that a new internet based application has been developed that will allow providers to submit notification electronically to Louisiana Medicaid. The application is available at www.lamedicaid.com.

Providers should be able to access the secured Provider's Notification Internet Application using their existing provider login ID. After selecting TPL-Provider Notice to Pursue Difference, the provider can submit the form online to Medicaid Recovery. Providers still have the option to mail the form to The Department of Health and Hospitals, Medicaid Recovery, P.O. Box 4909, Baton Rouge, LA 70821-4909, or fax the form to (225) 342-1376.

ATTENTION RHC/FQHC PROVIDERS
SYSTEMATIC ADJUSTMENT OF CLAIMS FOR ADJUNCT SERVICES

RHC/FQHC providers were notified in April 2010 that the programming to allow for reimbursement of adjunct services was implemented 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 were systematically adjusted on the RAs of 6/29/2010, 7/13/2010 and 7/27/2010. 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.

UPDATE REGARDING RATE REDUCTIONS AND CLAIMS ADJUSTMENTS FOR
PROFESSIONAL SERVICES PROVIDERS

In response to concerns received from professional service providers affected by retroactive claims adjustments for reductions put in place over the last year, weekly adjustments have been postponed effective July 27, 2010 until further notice.

These weekly claim adjustments were intended to reduce the financial impact of the cuts by spreading the recoupment over time. However, we do recognize that many providers would prefer a single recoupment for accounting purposes. Medicaid providers who prefer claim adjustments to be placed into a single week's checkwrite should notify Louisiana Medicaid by sending an email to medicaidprofessionalservices@la.gov, or by letter to:

Medicaid Professional Services
P.O. Box 91030
Baton Rouge, LA 70821

Correspondence should include the full name of the provider and Medicaid provider ID number, along with the full name, title, and contact information for the authorizing individual.

DHH would also like to take this opportunity to educate providers on the availability of electronic remittance advice. These may already be available to you through your billing agent. Providers may contact the EDI department at Molina regarding the 835 transaction (electronic RA) at 225-216-6303 or by email at *hipaaedi@unisys.com. 

DHH is continuing to explore options to reduce the impact of these adjustments. Providers should continue to monitor RAs and www.lamedicaid.com for updates.

UPDATE ON 'CLAIMCHECK' DENIALS RELATED TO MODIFIER-51

The resolution to the modifier -51 issue necessitating that providers delay the resubmission of claims that received 'ClaimCheck' denials for errors 934 (Modifier 51 Required-ClaimCheck) and 938 (Modifier 51 Invalid-ClaimCheck) is close to completion. Testing of this update to the claims processing system is currently in progress and it is anticipated it will be complete in the next few weeks. To expedite proper payment for providers, when the update is complete, claims previously denied for these errors will be recycled. Providers will not need to take any action. Providers will be notified when the update is complete and provided with details of the recycle via notices on the Louisiana Medicaid website homepage at www.lamedicaid.com, under the 'ClaimCheck' icon on the website, as well as on their RA messages. For further questions related to this matter, please contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.