RA Messages for August 05, 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. 

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.      

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.  

COMMUNITYCARE AND NPI 

CommunityCARE PCPs currently use their 7-digit Louisiana Medicaid legacy provider id when issuing CommunityCARE referrals/authorizations. Effective immediately, PCPs should begin placing both their legacy provider id and the NPI registered with la Medicaid on all written referrals/ authorizations. PCPs should continue to use only their 7-digit legacy ID when issuing ER post-authorizations via the e-RA system. PCPs enrolled as physician groups, RHCs, or FQHCs should remember that enrollees are linked to the entire practice, not the individual physicians, and must issue referrals/authorizations with the legacy provider id and npi registered for the physician group, RHC, or FQHC.