RA Messages for August 24, 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.

UPDATE REGARDING RATE REDUCTIONS AND CLAIMS ADJUSTMENTS FOR
PROFESSIONAL SERVICES PROVIDERS

In response to concerns received from professional services providers affected by the rate reductions put in place over the last year, weekly retroactive claims adjustments were postponed effective July 27, 2010. The Department will resume these adjustments beginning in late September. Providers should refer to www.lamedicaid.com on Tues, Aug 24, 2010 for a memorandum that will provide details. The memorandum provides a means by which providers can inquire about an alternative payment plan, request an estimated total dollar amount of the adjustment balance, or to submit questions.

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.