RA Messages for September 25, 2018

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 http://www.lamedicaid.com.

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

ATTENTION: LTC and ICF-DD PROVIDERS

Louisiana Medicaid UB-04 Billing Instructions Manual for Nursing Facility and ICF-DD, has long contained policy requiring Long Term Care and ICF-DD Providers to include a Principal Diagnosis when billing transactions. Previously, there wasn’t an edit in place to validate a valid ICD-10 code was reported- but that will now change.

Effective for Dates of Service August 28, 2018 and forward, Medicaid will implement an edit requiring a valid ICD-10 diagnosis code is reported in the principal diagnosis field. Claims submitted without a valid principal diagnosis code will be denied for correction.

Louisiana Medicaid UB-04 Billing Instructions Manual for Nursing Facility and ICF-DD identifies Other Diagnosis Field as a situational field. While reporting Other Diagnosis is not required, effective with dates of service August 28, 2018 and forward, Medicaid will implement an edit to deny the claim for correction when an invalid ICD-10 code is reported in the Other Diagnosis Field.

ATTENTION ALL PROVIDERS
INCORRECT USE OF ICD-10 CODES WILL RESULT IN CLAIM DENIALS

Louisiana Medicaid will be completing the final transition from the ICD-9 Crosswalk to the ICD-10 Code set with date of processing September 4, 2018 forward. Once implemented, ICD-9 codes will no longer be accepted on claims with dates of service 10/1/2015 and after. Below are common provider errors identified during testing that will result in future claim denials.

Invalid ICD-10 codes
Header codes sent as ICD-10 codes are non-payable
ICD-9 codes in ICD-10 fields

Effective September 4th, 2018, Medicaid will implement edits requiring a valid ICD-10 diagnosis code to be reported in the principal diagnosis field. Claims submitted without a valid principal diagnosis code will denied. The edits will include:

433 – Missing/Invalid Diagnosis
131 – Primary Diagnosis Not on File
132 – Secondary Diagnosis Not on File
151 – Mixed ICD Code Sets
152 – Invalid ICD Code on Date of Service

When determining diagnoses, please ensure the diagnosis is applicable for the age and gender of the patient on the billed claim. The age and gender restrictions on the ICD-10 code set are from CMS guidelines and are tighter than currently in the system for the ICD-9 code set.

ATTENTION: Provider Portal Login Update on LAMEDICAID.com

On Friday September 21, 2018, Molina will install an enhanced version of its provider portal on LAMEDICAID.com in partnership with the Louisiana Department of Health. With your first login, you will be required to update your password, profile, and answer three security questions. Please take this opportunity to update your user information such as email address and phone number. For security purposes, the Provider Applications page has been simplified to display applications based on information such as provider type, specialty, and enrollment status.