RA Messages for August 17, 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
UPDATE TO PRECERTIFICATION POLICY RELATED TO INPATIENT PHYSICIAN CLAIMS
Effective
with date of service August 30, 2010, in conjunction with the updates to
the precertification/length of stay criteria for all acute hospital
stays, the claims processing edits have been updated related to
physicians' inpatient services. Physician inpatient services will
continue to be edited to assure that the inpatient hospitalization has
been precertified/approved. When there is no approved precertification
on file, the inpatient physician services will deny. For a description
of exceptions related physician charges when hospital stays are not
precertified, refer to the 2007 Professional Services Training manual,
page 76. For further questions related to this matter, please contact
Molina Provider Relations at (800) 473-2783 or (225) 924-5040.
ATTENTION ALL
PROVIDERS
IMPLEMENTATION OF AUG 1, 2010 RATE REDUCTIONS
After
careful analysis of the state budget approved for fiscal year 2010 -
2011 by the Louisiana Legislature, the Department of Health and
Hospitals (DHH) has developed a plan to manage a $168.1 million total
budget reduction. This reduction equates to 4.6% of the enacted budget
for the Medicaid Private Provider Program.
The state has published Emergency Rules which address these program
reductions which can be found online at the Office of State Register's
website at http://www.doa.louisiana.gov/OSR/osr.htm by clicking on the
Emergency Rules tab on the left navigation bar of the homepage. Refer to
the homepage of the LA Medicaid website (www.lamedicaid.com) for a
summary of these rules and a link to the LA Register.
Providers
will be notified when the new rates are loaded for each program. At that
time, providers should reference the LA Medicaid website for the most
current fees. Claims for dates of service after August 1, 2010 that are
adjudicated prior to the system update will be systematically adjusted
and no action is required by providers. Continue to monitor future RAs.
Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040
with questions related to the implementation of the rate reductions and
claim adjustments.
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.
ATTENTION FREE
STANDING REHABILITATION CLINICS, OUTPATIENT
HOSPITAL REHABILITATION CENTERS AND HOME HEALTH PROVIDERS
It is no longer
necessary to include the PA-02 form with Prior Authorization requests
for physical, occupational or speech therapy to be provided in an
out-patient facility or in the recipient's home as long as the following
are included: a completed PA-01 form, a signed and dated prescription,
and a dated therapist's evaluation or current progress notes which
states the recipient's plan and lists the proposed goals. Effective with
date of processing July 19, 2010, Molina will no longer deny requests
for rehabilitation services due to no PA-02 form being submitted with
the PA packet. All Prior Authorization requests must still include for
processing the Therapist's Evaluation/ Progress Notes and the signed
Physician's Prescription for services.
ATTENTION
LABORATORY, RADIOLOGY, AND ASC (NON-HOSPITAL) PROVIDERS
IMPLEMENTATION OF AUG 2010 REIMBURSEMENT RATE REDUCTIONS
The reimbursement rate
reductions effective with dates of service on or after August 1, 2010
for laboratory, radiology, and ASC (Non-Hospital) have been loaded in
the system. Providers should reference the "Fee Schedules" link on the
homepage of the LA Medicaid website (www.lamedicaid.com) for the most
current fees. These rate reductions will begin appearing on the RA of
August 10, 2010. A systematic adjustment of claims will be unnecessary
due to timely implementation. Contact the Provider Relations unit at
800-473-2783 or 225-924-5040 with questions concerning the rate
reductions.
REHAB CENTERS,
AMBULANCE TRANSPORTATION, KIDMED SCREENING CLINICS,
DME, MOBILE X-RAY/RADIATION THERAPY CENTERS & OPTICAL SUPPLIERS
As detailed in the RA
published in June/July 2010, there are claims that reimbursed
referencing the wrong fee on file on the RA's of 5/25/10, 6/1/10,
6/8/10, and 6/15/10. The fees & programming logic were updated and
claims that previously reimbursed erroneously will be systematically
adjusted on the RA of 8/10/10. No action is required by providers. A
detailed list of the codes impacted has been posted on
www.lamedicaid.com. Please contact the Provider Relations unit at (800)
473-2783 or (225) 924-5040 with questions concerning the error and
adjustment of claims.
URGENT CARE
FACILITIES AND RETAIL CONVENIENT CARE CLINICS
Effective with date of
service July 1, 2010, qualified providers may enroll in Louisiana
Medicaid with an Urgent Care Facility or Retail Care Clinic
subspecialty. Providers with Urgent Care or Retail Convenience Care
designation will no longer require the PCP's referral/ authorization to
be reimbursed by Medicaid. This requirement is being eliminated in order
to facilitate access to after-hours medical care and reduce costs
associated with Emergency Room utilization for non-emergent conditions.
Requirements for these provider subspecialties and instructions for
enrolling with this subspecialty can be found on the Medicaid provider
website, or by contacting Provider Relations at (800) 473-2783.
ATTENTION ALL
PROVIDERS
IMPLEMENTATION OF JANUARY 2010 PHYSICIAN ADMINISTERED DRUGS
RATE ADJUSTMENTS
The reimbursement rate
adjustments for physician administered drugs effective with date of
service January 22, 2010, have been implemented. Providers will begin
seeing these reductions on the RA of August 17, 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 visit
the LA Medicaid website, www.lamedicaid.com, for updates to the
Professional Services Fee Schedule. The adjustment of claims for
physician administered drugs paid between January 22, 2010 - August 17,
2010 will be included in the upcoming adjustment of professional
services claims for the August 2009 and January 2010 rate reductions.
There is still a delay in implementing these adjustments as we assess
available options for providers. 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
DME PROVIDERS - INCLUDING PHARMACIES PROVIDING
DME SERVICES
In the near future, LA
Medicaid will require DME providers to submit NDC information on PA
requests and associated claims for enteral therapy products. This
requirement applies to all DME providers, including pharmacies that
dispense the DME supplies to Medicaid recipients. Please visit the LA
Medicaid website, www.lamedicaid.com, frequently for the effective date,
the list of products and associated NDC data, and other detailed
information related to this requirement.
ATTENTION
HOSPITAL PROVIDERS AND PHYSICIAN PROVIDERS
PRECERTIFICATION CHANGES
Effective August 30,
2010, two significant changes will take place concerning hospital policy
and Precertification requirements:
1. Change in policy for the outpatient 24 hour rule.
2. Change in requirement for Hospital Precertification of deliveries and
accompanying billing changes.
Please visit www.lamedicaid.com for detailed provider notices concerning
these changes.