RA Messages for
September 6, 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.
'CLAIMCHECK' PROCESSING UPDATE FOR ADD-ON
PROCEDURE CODES
Effective with the Remittance Advice of August 18,
2011, claims processing will now also "look" for a paid primary
procedure code in claims history before the final adjudication of the
add-on code. Prior to this update, both the primary and the add-on codes
had to be submitted on the same claim and processed through ClaimCheck
at the same time. Add-on procedure codes will continue to deny if they
go through ClaimCheck while the primary code is in Medical Review. In
this circumstance, providers must re-submit the add-on code after the
primary code has been paid.
Claims that have received denial error code 945
(add-on procedure is invalid without primary) will be systematically
recycled. No action is required by the provider. Those add-on codes that
have the appropriate primary code paid in history should now be
reimbursed. Some claims may continue to deny with the 945 denial code or
for a different reason. The recycle is anticipated to occur on the
remittance of August 25, 2011. Please contact Molina Provider Relations
at (800) 473-2783 or (225) 924-5040 if there are questions.
ATTENTION PROFESSIONAL SERVICE PROVIDERS
FEE SCHEDULE IN EXCEL FORMAT
The department is pleased to inform you that the Physician's Fee
Schedule is now available in excel format. Providers are encouraged to
visit the LA Medicaid website (www.lamedicaid.com) to view the fee
schedule at your convenience. Please contact the Provider Relations unit
at (800) 473-2783 or (225) 924-5040 with any questions.
ATTENTION PROFESSIONAL SERVICES PROVIDERS
PATHOLOGY CONSULTATIONS PERFORMED DURING SURGERY
A system issue has been identified, which was causing claims billed for
the professional component of procedure codes 88333 (pathology
consultation during surgery; cytologic examination, initial site) and
88334 (pathology consultation during surgery; cytologic examination,
each additional site) to deny with error code 182 (procedure claim type
conflict) when performed in the hospital setting. This system issue has
been corrected and claims billed on or after August 12, 2011, should
process appropriately. Claims that previously denied for this issue for
dates of service October 1, 2009, through August 11, 2011, that were
adjudicated prior to August 12, 2011, will be recycled on September 6,
2011, and no action is required from providers. Please contact the
Molina Provider Relations unit at (800) 473-2783 or (225) 924-5040 with
questions concerning this issue.