RA Messages for September 21, 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 PROVIDERS

Pursuant to House Concurrent Resolution 94 passed during the 2010 legislative session, the Direct Service Worker Registry rule published in the Louisiana Register, Vol. 32, No. 11, November 20, 2006 has been suspended temporarily. DHH will not enforce compliance with these requirements during this time; however, the Registry will continue to accept forms from providers that want to register workers on a voluntary basis. For further information on this legislation, please visit the DHH Health Standards website at http://www.dhh.louisiana.gov/office/?ID=112. Link to DSW Registry under "Featured Services."

ATTENTION DENTAL PROVIDERS

Effective for dates of service on and after August 1, 2010, the dental procedure code for Prefabricated Esthetic Coated Stainless Steel Crown-Primary Tooth (D2934) is reimbursable by Medicaid in the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Dental Program. Complete details can be located on the www.lamedicaid.com website under the 'Dental Providers' and 'Fee Schedules' links. Contact the LSU Dental Medicaid Unit at 504-941-8206 or 866-263-6534 (toll-free) with any questions.

REVISED CLAIMCHECK MULTIPLE SURGERY/MODIFIER-51 PROCESSING

Beginning with the September 7, 2010 date of processing, ClaimCheck editing related to multiple surgical procedures during the same surgical session performed by the same provider has been updated. This update was necessary to prevent inadvertent duplicate denials and to properly apply the multiple surgery reductions based on industry standards including the relative value units for the procedures. In addition, this revision will now expedite correct payment and prevent additional administrative burden for providers by minimizing the need to resubmit claims where the -51 modifier was incorrectly applied. With this update, when the -51 modifier has or has not been applied to the appropriate procedure(s), the system will now add or remove the -51 modifier from the claim and will then process and reimburse the claim accordingly. The denial codes previously used (errors 934 and 938) will now reflect an educational message (EOB) indicating whether the -51 modifier was added or removed from the procedure code for processing.

Providers will see the following EOB messages when these edits occur:
934: Modifier 51 required. Added to claim-ClaimCheck.
938: Modifier 51 invalid. Removed from claim-ClaimCheck.

When all procedures of the same surgical session have adjudicated, overpayments identified by providers are to be handled via the current adjustment/void process. As part of the on-going assessment and adjustments in claims processing related to the implementation of ClaimCheck editing, Louisiana Medicaid anticipates minimizing current hard copy requirements related to surgical procedures wherever possible. Providers will be notified as these improvements occur.

Providers should note that claims adjudicated prior to ClaimCheck implementation were subject to reimbursement policy and practices on the date of adjudication.

The recycle of claims that have been previously denied for errors 934 and 938 since the implementation of ClaimCheck editing is anticipated to occur on the R/A of September 14, 2010. For further questions, please contact Molina Provider Relations at 225-924-5040 or 800-473-2783.

RECYCLE STATUS OF CLAIMCHECK MODIFIER -51 DENIALS

The recycle of claims that have been previously denied for errors (934 and 938) related to modifier -51 will not appear on the R/A of September 14, 2010, as anticipated in a previous message. (The recycle will apply only to those claims denied with these errors prior to the update related to modifier -51 that was effective with the date of processing of September 7, 2010.) Testing of the recycle is underway as a priority and is expected to be finalized within the next few weeks. Providers will be notified when the testing is complete and provided with pertinent details about the recycle. Please continue to monitor the Louisiana Medicaid website homepage at www.lamedicaid.com, under the ClaimCheck icon on the website, as well as RA messages for the latest information. For further questions related to this matter, contact Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
UPDATE REGARDING RATE REDUCTIONS AND CLAIM ADJUSTMENTS

Providers affected by the claim adjustments for the Aug 4, 2009 and January 22, 2010 rate reductions will see their remaining adjustments on one midweek RA, either on September 22 or October 6. Refer to the memorandum published 8/25/10 on www.lamedicaid.com. Please note that one of the following two scenarios will occur unless an alternative payment plan is requested: 1) If the balance due is less than $500, the full amount will be withheld from the normal weekly RAs following the midweek adjustment RA. 2) If the balance due is greater than $500, it will be divided and applied in equal amounts to the normal weekly RAs following the midweek adjustment RA & continue through June 7, 2011.

Providers interested in an alternative payment plan, send an email as soon as possible to medicaidprofessionalservices@la.gov detailing your request. Please enter "Alternative Payment Plan" in the subject line.

ATTENTION FREE STANDING ESRD FACILITIES
DELAYED IMPLEMENTATION OF AUG 2010 RATE REDUCTIONS

Effective with dates of service on or after August 1, 2010, the reimbursement rates for Free Standing ESRD Facilities are further reduced by 4.6%. For details regarding these reductions, please refer to the rules published on the Office of the State Register's website (http://doa.louisiana.gov/osr). Complex system changes have resulted in delayed implementation of these reductions. Claims adjudicated prior to implementation of the reductions will be assessed to determine an approach to systematic adjustment. No action is required by providers. Continue to monitor RA's and www.lamedicaid.com for status updates. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the implementation of the rate reductions.

ATTENTION COMMUNITYCARE PROVIDERS
COMMUNITYCARE ENHANCED FEES ENDING

Effective August 1, 2010, the CommunityCare enhanced reimbursement rates for select primary care services ended. CommunityCare providers will be reimbursed based on the applicable fee on Professional Services Fee Schedule. The CommunityCare monthly management fee remains in place. Providers will see these changes on the RA of September 28, 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.

Claims for dates of service August 1, 2010-September 21, 2010 that were adjudicated prior to September 21, 2010 are currently being assessed to determine an approach to a systematic adjustment. No action is required by providers. Continue to monitor future RAs for details regarding when the recycle of these claims will take place. Should you have questions concerning this change, please contact Provider Relations at (800) 473-2783 or (225) 924-5040.

ATTENTION FREE STANDING END STAGE RENAL DISEASE (ESRD) FACILITIES
IMPLEMENTATION OF JANUARY 22, 2010 RATE REDUCTIONS

Effective with dates of service on or after January 22, 2010, the reimbursement rates for Free Standing ESRD Facilities are reduced by 5%. Complex system changes initially resulted in delayed implementation of these reductions, but they have now been implemented. Providers will begin seeing these reductions on the RA of September 28, 2010. Refer to the Office of State Register's website at http://doa.louisiana.gov/osr/ for published rules detailing these reductions. Claims that were adjudicated prior to September 21, 2010 are currently being assessed to determine an approach to a systematic adjustment. No action is required by 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.