RA Messages for
August 10, 2011
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 INPATIENT ACUTE HOSPITAL PROVIDERS
CHANGE IN RETROSPECTIVE REVIEW PROCESS
In November of 2010, DHH changed the requirements for
the retrospective review process for Acute Inpatient Hospital Providers.
Since then, DHH has monitored this process and listened to the
suggestions and concerns of the hospital providers. Beginning August 1,
2011, a new retrospective review process will be implemented. Please
visit the Medicaid website at www.lamedicaid.com to review the amended
process. Please note that this new process only applies to Acute
Inpatient Hospitals and does not apply to Psychiatric, LTAC, or Rehab
Hospitals.
ATTENTION PROVIDERS OF PRENATAL AND PEDIATRIC
CARE SERVICES
Louisiana Medicaid reminds providers of the Medicaid
Prenatal and Preventive Pediatric Care Pay and Chase policy, as
published in the 2006 Louisiana Medicaid Basic Services Provider
Training, page 40. This policy addresses certain prenatal and pediatric
preventive care services including immunizations (see bullet #2 of the
policy), when the Medicaid enrollee also has a private health insurance
carrier.
Providers accepting primary health insurance and Medicaid as secondary
coverage for a Medicaid recipient should follow the Pay and Chase policy
for all services identified in the policy. If providers choose not to
follow the pay and chase policy for services included in this policy,
the recipient cannot be billed for Medicaid covered services. Example: A
child requires a Medicaid covered childhood immunization(s) and has both
private health insurance as well as Medicaid as secondary coverage. The
Medicaid provider should use vaccines obtained from the Vaccines for
Children (VFC) program to immunize the child and bill Medicaid directly.
If the provider does not follow this policy and utilizes privately
purchased vaccines, and if the private insurance carrier denies the
immunization claim, Medicaid will not reimburse providers for the
vaccine serum used and the provider cannot bill the recipient for the
vaccine nor for the administration of the vaccine.
If a provider elects to not accept a recipient's Medicaid as secondary
coverage, Louisiana Medicaid encourages providers to obtain signed
documentation, prior to services being rendered, indicating the Medicaid
recipient was made aware that the provider was not accepting Medicaid as
secondary coverage, and that the recipient could be responsible for
payment of services not covered by the private insurance.
Contact Molina Medicaid Solutions Provider Relations at (800) 473-2783
or (225) 924-5040 should you have any questions.
ATTENTION ALL PROVIDERS
The checkwrite schedule for the month of August 2011
is as follows:
Thursday August 4, 2011
Wednesday August 10, 2011 (Long Term Care and all other combined)
Thursday August 18, 2011
Thursday August 25, 2011
EDI cut-off is 10:00 AM on the Thursday preceding the check write date.
ATTENTION PROFESSIONAL SERVICE
PROVIDERS
PHYSIATRISTS MANAGING INTRATHECAL BACLOFEN THERAPY
Effective with date of service August 1, 2009, Louisiana Medicaid
reimburses physiatrists for intrathecal baclofen pump management.
Services that may be provided by a physiatrist include pump analysis,
programming, refill, and maintenance. Providers are encouraged to refer
to the Current Procedural Terminology manual for instructions on how to
bill for these services.
Please contact the Molina Provider Relations unit at (800) 473-2783 or
(225) 924-5040 with questions concerning this issue.
ATTENTION ALL PROVIDERS OF DURABLE MEDICAL EQUIPMENT
All providers who provide Durable Medical Equipment (DME) that are not
exempted from accreditation should submit their documentation for
accreditation by July 31, 2011. DME providers without certificate of
accreditation on file by August 31, 2011, will have their provider
numbers closed on that date.
Closed DME providers will have three months, or 90 days, to submit the
documentation and retain their enrollment status in Louisiana Medicaid.
After the 90 day period, a new enrollment packet will need to be submitted along with the accreditation documentation to reinstate their
provider numbers.
ATTENTION PROFESSIONAL SERVICE PROVIDERS
BILLING DIAGNOSTIC HEART CATHETERIZATIONS
It has been brought to the Department's attention
that clarification is needed regarding the billing of a therapeutic
cardiovascular intervention on the same date of service as a coronary
angiography. This message is intended to provide clarification for
providers who perform and bill for these services.
Coronary angiography without concomitant left heart catheterization
should not be billed to report catheter introduction and position within
the vessel when performing a therapeutic cardiovascular intervention
(such as balloon angioplasty and intracoronary stent placement). This is
considered an integral part to the primary procedure; therefore, it
should not be reported separately.
The only instance when it would be appropriate to
report coronary angiography without concomitant left heart
catheterization on the same date of service as a therapeutic
cardiovascular intervention would be if a true diagnostic angiography
was performed, and documentation supports the performance and necessity
for the procedure. Instances which would be appropriate for separate
reimbursement include occasions in which no previous angiographic study
is available, insufficient previous angiography, or a change in the
patient's condition. In order to appropriately bill for both of these
services on the same date of service, providers should append the
coronary angiography with the appropriate modifier to identify it as a
distinct procedural service.
Providers are reminded that the medical record acts
as the only means to support services billed. If the medical record does
not support the necessity and performance of a true diagnostic
angiography, the claim for the angiography will be determined as an
overpayment and is subject to recoupment.
Please contact the Molina Provider Relations unit at (800) 473-2783 or
(225) 924-5040 with questions concerning this issue.