RA Messages for August 18, 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 PROFESSIONAL SERVICES PROVIDERS
COCHLEAR IMPLANT POST-OPERATIVE PROGRAMMING CODES
Effective with date of service July 1, 2006 forward, Louisiana Medicaid
reimburses for cochlear implant post-operative programming codes
(current CPT code range 92601-92604). Providers are to adhere to
national standards and CPT guidelines when billing for these services.
If nationally approved changes occur to these CPT codes at a future
date, providers are to follow the most accurate coding available for
covered services for that particular date of service, unless otherwise
directed. Medicaid payments received by providers for inappropriate
services are subject to review, recoupment and sanction. A systematic
recycle of claims that originally denied for "procedure/type of service
not covered by program" will be completed in the near future. No action
is necessary by providers. Notification will be made via remittance
advice message when the recycle occurs.
ATTENTION
PROVIDERS OF TAKE CHARGE FAMILY PLANNING WAIVER SERVICES
The TAKE
CHARGE Program is limited to coverage of family planning services ONLY,
and only those services are approved and payable. The approved list of
diagnosis codes is available in the documentation for this program
online at www.takecharge.dhh.louisiana.gov, and the family planning
diagnosis MUST be the primary diagnosis on any claim for TAKE CHARGE
recipients. This supports the fact that you are seeing the patient for
family planning services and billing Medicaid for those services. If
reporting other diagnoses on the claim is appropriate, they should be
reported as additional diagnoses. Also, please remember, if services
other than the covered family planning services are in order, the
recipient should be informed prior to the visit/prior to providing the
services that such services are not covered through the TAKE CHARGE
Program.
ATTENTION
MULTI-SYSTEMIC THERAPY (MST) PROVIDERS
We have made a
change to claims processing for Multi-Systemic Therapy services to allow claims
to be processed on the same date of service if the Place of Treatment/Place of
Service is different. Claims that were denied for error 689 (MHR SERVICES
ALREADY PAID FOR THIS DATE OF SERVICE) for MST services with a different Place
of Treatment are being systematically recycled on the 8/18/09 RA. No provider
action is necessary.
ATTENTION
HOSPITAL PROVIDERSS
Review of claims
related to the NDC implementation has revealed that some providers are
submitting NDC data with inappropriate revenue codes.Effective August 31, 2009,
for the RA of September 8, 2009, a new edit
will be implemented to deny outpatient hospital claim lines when NDC
data is reported with a revenue code that is not in the 250-259 or
630-639 range. The new edit is 545, Revenue Code Invalid for Reporting
NDC Info. Hospital providers must ensure that NDC data is reported
with correct revenue codes in order to eliminate unnecessary denials.