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 http://www.lamedicaid.com/. 

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

Billing of Shared Plan Claims to Molina after July 31, 2015

Claims for Bayou Health Shared Savings Plan members formerly enrolled in CHS or UHC with dates of prior to February 1, 2015, should be submitted for payment to the appropriate Shared Savings Plan no later than July 31, 2015. After July 31, 2015, claims for these members must be submitted directly to Molina for payment. Claims submitted to CHS and UHC after July 31, 2015 will deny with edit 998 “submit claim to Molina for processing”.

When submitting claims to Molina, please adhere to the instructions below:

  • Hard Copy Claims – Use billing instructions provided for your provider/claim type found at http://www.lamedicaid.com/provweb1/billing_information/medicaid_billing_index.htm. Reminder: Always submit claims with the 13 digit Medicaid Recipient ID and 7 digit Legacy Medicaid provider number for billing and servicing providers when submitting claims to Molina. Include appropriate attachments and/or proof of timely filing if necessary.
  • Electronic Claims – Use the appropriate 837 electronic transaction in the 5010 HIPAA Companion Guide for your provider/claim type found at http://www.lamedicaid.com/provweb1/HIPAA/5010v_HIPAA_Index.htm. Again, always submit claims with the 13 digit Medicaid Recipient ID number.

If you have any questions, please contact Molina’s Provider Relations at 1-800-473-2783.

Attention Pharmacists of Louisiana Medicaid Fee for Service:

Effective July 24, 2015, reimbursement of the dispensing fee and provider fee will be itemized out separately on Fee for Service pharmacy claims. Dispensing fee will be remitted at a maximum allowable of $10.41 in NCPDP field 507-F7 (dispensing fee paid). Provider fee will be remitted at $0.10 per paid claim in NCPDP field 558-AW (flat sales tax paid). Previously, both the dispensing fee and provider fee were remitted together at a maximum allowable of $10.51 in NCPDP field 507-F7 (dispensing fee paid).

ATTENTION LABORATORY PROVIDERS:

Coverage of the professional component for Current Procedural Terminology (CPT) code 88361 (Morphometric analysis…computer assisted…) has recently been added by Louisiana Medicaid. This change is effective for dates of service on or after January 1, 2014. The laboratory fee schedule has been updated to reflect this change. Previously denied claims for the professional component on CPT code 88361 due to non-coverage will be systematically recycled on the RA of July 28, 2015 without any action required on behalf of the provider.

Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.

ATTENTION PROFESSIONAL SERVICES PROVIDERS:
REIMBURSEMENT RATE CHANGE FOR 17P (J3490-TH)

The Louisiana Medicaid program has received CMS approval for a reimbursement rate adjustment related to Healthcare Common Procedure Coding System (HCPCS) code J3490-TH (17 Alpha-Hydroxyprogesterone Caproate). The updated pricing will be effective with date of service June 20, 2015.

Providers reimbursed at the previous rate on or after date of service June 20, 2015 may submit an adjustment to receive the updated rate.

The fee schedules will be updated in the near future reflecting this change on the Louisiana Medicaid website at www.lamedicaid.com.

Please contact Molina Provider Relations (800)473-2783 or (225) 924-5040 for questions regarding this 17P reimbursement rate change.

Attention Extended Home Health Providers: Multiple Recipients in the Same Home

Effective for new prior authorizations with dates of service June 15, 2015 and after, when there are multiple recipients in the same home on the same date of service, providers should append the TT modifier to only one recipient's authorization and subsequent claims per date of service. The TT modifier would not be appended to the other recipient's authorization or claims on the same date of service. Claim submission must reflect the authorization for the specific recipient in the home on a date of service. This updated process will allow claims to process and reimburse correctly. Claims appended with modifier TT will be reimbursed at fifty percent of the fee on file.

This policy clarification only applies when there are multiple recipients in the same home on the same date of service using procedure codes S9123 and S9124.

For questions related to this information as it pertains to legacy Medicaid claims, please contact Molina Medicaid Provider Solutions at (800) 473-2783 or (225) 924-5040.

Attention New Opportunities Waiver, Children’s Choice Waiver, Residential Options Waiver Providers

Effective dates of service 9/1/15, Louisiana Medicaid will no longer accept the deleted modifier 'RP' for parts related to repairs of DME equipment for Procedure code T2029. Providers should begin using modifier 'RB' (Replacement of a part of a DME furnished as part of a repair) in these instances. Please make the necessary changes in your procedures and systems to ensure that you are requesting PA and billing with the new modifier.

ATTENTION PROVIDERS OF ‘TAKE CHARGE PLUS’ SERVICES
CORRECTIONS TO CLAIMS PROCESSING

The following corrections have been made to the Take Charge Plus program’s claims processing:

  • To allow Affordable Care Act enhanced payments that denied incorrectly for edit 251(deny for diagnosis).
  • To allow mid-level providers to be reimbursed 100% of the physicians’ fee on file for administered injections, LARCs, immunizations, and EPSDT preventive medical screenings.
  • To allow FQHCs, RHCs, and American Indian “638” clinics to be reimbursed at fee for service rates.
  • To allow previously denied outpatient ambulatory surgery claims to process and reimburse correctly.

Impacted claims will be recycled on the 08/18/15 Remittance Advice (RA).
For questions, please contact Molina Medicaid Services at (800) 473-2783 or (225) 924-5040.

Attention Durable Medical Equipment Providers

Effective dates of service 9/1/15, Louisiana Medicaid will no longer accept the deleted modifier 'RP' for parts related to repairs of DME equipment. Providers should begin using modifier 'RB' (Replacement of a part of a DME furnished as part of a repair) in these instances. Please make the necessary changes in your procedures and systems to ensure that you are requesting PA and billing with the new modifier.

For questions related to this information as it pertains to Legacy Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION PROVIDERS OF LAB SERVICES

On Remittance Advice 8/4/2015, some providers received denials for the reason codes identified below. These denials were made in error. Therefore, the identified denied claims will be recycled for correct processing on the 8/11/2015 RA. No action is required by providers and we apologize for any inconvenience this has caused.

Error Code 227 - Behavioral Health Crossover sent to BYU Plan
Error Code 228 - Submit Claim to BYU Plan
Error Code 229 - Submit Claim to CSOC Provider (Magellan)

If you have any questions, please contact Molina’s Provider Relations at 1-800-473-2783.

Attention ALL Adult Day Health Care (ADHC) Providers

Due to requests from providers, the billing cycle for ADHC is changing from the monthly LTC billing cycle to weekly billing.

  • The last monthly cycle ADHCs will bill for are dates of service for the month of August 2015. Prior to going straight to a weekly billing cycle, there will be a transition period during September 2015. Please note the following: During this transition time ADHC providers may not begin to submit claims weekly until after the August monthly checkwrite of Thursday, September 10, 2015.
  • With this transition to weekly billing, ADHC claims will begin being included in the DHH pre-payment review process. As with all other claims paid weekly, ADHC claims will pend with edit 241 (claims held for pre-payment review) for an additional week before being released for payment. This means providers that submit claims by 12 noon Thursday, September 17, 2015 will not receive reimbursement for those claims until the RA of September 29, 2015.

After the checkwrite of September 29, 2015, then ADHCs will be on the “regular” weekly checkwrite. At that time, ADHC providers should expect to see all approved claims pend for one additional week with the 241 pend edit.

Weekly checkwrites are on Tuesdays. Providers must ensure that they submit claims to Molina by Thursdays at noon in order for the claims to process and appear on the RA the following Tuesday. Because ADHC services are post authorized, ADHC providers should send information files to SRI at least two days prior to submitting claims to Molina.