RA Messages for July 28, 2009
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.
Detailed LMAC and FUL
changes are posted on
www.lamedicaid.com.
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
HOSPITAL PROVIDERS OF OUTPATIENT SERVICES
Louisiana Medicaid is now accepting
Outpatient claims with procedure code 99291 (critical care) as one of
the acceptable codes (along with 99281-99285) that can be billed with
Revenue codes of HR450 or HR459. Outpatient claims that denied with this
procedure code previously will be recycled for Dates of Service 7/1/2008
to current. These claims should appear on the RA of 7/7/2009. No
provider action is necessary.
ATTENTION
PROVIDERS SUBMITTING 837I TRANSACTIONS
You were recently notified of the
delay in requiring entry of the 10-digit National Provider Identifier (NPI)
as the CommunityCARE Primary Care Physician (PCP) Referral Authorization
Number on 837I electronic data interchange (EDI) claims transactions.
DHH is implementing new requirements for service providers who must
transmit the PCP Referral Authorization Number in 837I transaction.
Please review the provider notice found on the Louisiana Medicaid
website home page at www.lamedicaid.com for details of this change.
POLICY UPDATE:
AMBULATORY SURGICAL CENTERS (NON-HOSPITAL)
REIMBURSEMENT FOR CORNEAL TISSUE
Effective with date of service September 1, 2008, in addition to the
facility fee for the surgery, Louisiana Medicaid will reimburse
the ASC for corneal tissue (currently HCPCS code V2785) used in corneal
transplant procedures. It is the Department's intent that corneal
tissue be reimbursed only when a valid facility fee for the related
surgical procedure has been paid to the ASC on the same date of service
for the same recipient. As in all circumstances, providers are
expected to maintain appropriate records documenting the services
billed to Medicaid.
Only those corneal tissue claims for date of service September 1, 2008
and after will be considered for this payment methodology. ASC providers
that performed corneal transplants and were paid the facility fee for
corneal transplant surgery may now submit claims for the corneal tissue,
if applicable, for DOS September 1, 2008 forward. However, to prevent
inadvertent denials in the future, the ASC should bill for both the surgery and
the corneal tissue on the same claim. The situation is an
exception to current published Non-Hospital ASC policy stating "There
should only be one line item per claim form."
ATTENTION PHYSICIANS
Due to a claims processing error, some duplicate Medicare Part B claims
were paid in the past. All duplicate claims paid 7/1/07 or after are
being voided on the 7/28/09 RA. We regret any inconvenience this
processing error may have caused. Please contact Unisys Provider
Relations if you have any questions.
ATTENTION DENTAL PROVIDERS
Louisiana Medicaid enrolled dental providers are required to update
their provider contact information through the www.lamedicaid.com
website. The Provider Locator Information link allows providers to
update existing contact information and the option to indicate if
they are "Accepting New Medicaid Patients," which will then be viewable
to the public when using the Provider Locator Tool to locate Medicaid
providers. Complete details are located on the www.lamedicaid.com
website. Questions about the website may be directed to
Unisys Provider Relations at (800) 473-2783 or (225) 924-5040.