RA Messages for September 30, 2014

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 Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective October 1, 2014, Makena� (Hydroxyprogesterone Caproate) will now be covered as a pharmacy benefit in addition to the existing medical benefit coverage. Makena� prescriptions will require a diagnosis code to be submitted at Point of Sale (POS). Please refer to www.lamedicaid.com for specifics.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Louisiana Medicaid will reimburse enrolled pharmacies for influenza vaccines and the administration of the vaccines per program policy effective September 15, 2014. If you submit a pharmacy claim for a flu vaccine online through the Point of Sale (POS) system the Professional Service Code Medication Administration (MA) is required in the NCPDP field 440-ES. The following fields are also required as part of the POS claim: vaccine NDC, ingredient cost, incentive amount (administration fee), DUR/PPS Code Counter (value of 1), Prescriber ID, Provider ID, and Provider ID qualifier. See www.lamedicaid.com for more information and definitions of the POS fields.

New Louisiana Department of Health and Hospitals Adverse Actions Web Search:

As a condition of participation in the Louisiana Medicaid Program, providers are responsible for ensuring current and potential employees, contractors and other agents and affiliates have not been excluded from participation in the Medicaid, or Medicare Program by Louisiana Medicaid, or the Department of Health and Human Services� Office of Inspector General. Providers who employ or contract with excluded individuals or entities may be subject to penalties of $10,000 for each item or services the excluded individual or entity furnished.

Providers have been previously instructed to check the websites of the Department of Health and Human Services� Office of Inspector General at http://exclusions.oig.hhs.gov and the System for Award Management (SAM) website at https://sam.gov/portal/SAM#1 for any exclusion imposed at the federal level upon hire and monthly thereafter for employees and/or subcontractors that perform services that are compensated with Medicaid/Medicare funds. Please be reminded that the SAM site is only for entities, and providers do not need to check employees on the SAM site.

Effective immediately, providers should check the Louisiana Department of Health and Hospitals Adverse Actions website at https://adverseactions.dhh.la.gov upon hire and monthly thereafter for individuals and entities that have had adverse actions imposed. This is a user friendly site that allows single and multiple searches of individuals and entities. The user may also choose to export the database and have it available in an Excel spreadsheet. Providers are required to maintain proof in their records that checks were done for employees and/or subcontractors. This may be done by printing out the result of the search.

All current and previous names used such as first, middle, maiden, married or hyphenated names and aliases for all owners, employees and contractors should be checked. If an individual�s or entity�s name appears on these websites, this person or entity is considered excluded and is barred from working with Medicare and/or the Louisiana Medicaid Program in any capacity. If the exclusion is learned prior to employment the provider should not employ the person or entity. If the provider learns of the exclusion after hiring the provider must notify the Department of Health and Hospitals within ten working days of discovering the exclusion with the following information:

  • Name of the excluded individual or entity and
  • Status of the individual or entity (applicant or employee/contractor).

If the individual or entity is an employee or contractor, the provider should also include the following information:

  • Beginning and ending dates of the individual�s or entity�s employment or contract with the agency,
  • Documentation of termination of employment or contract, and
  • Type of service(s) provided by the excluded individual or entity.

These findings should be reported to:

DHH.Medicaid.State.Exclusion@la.gov or

Department of Health and Hospitals
Program Integrity
P.O. Box 91030
Baton Rouge, LA 70821-9030

This new adverse actions web search tool does not replace the Nurse Aide Registry/Direct Service Worker Registry found at www.labenfa.com. Providers that employee Certified Nursing Assistants (CNA) and Direct Service Workers (DSW) are still required to check these registries upon hire and every six months thereafter.

These requirements are identified in the Provider Enrollment Agreements, the Medical Assistance Program Integrity Law (MAPIL) cited as Louisiana Revised Statute 46:437, referenced in the Louisiana Administrative Code (LAC) Title 50 and the Code of Federal Regulations 42 CFR � 455.436.

All excluded individuals must request reinstatement after the minimum excluded period has been served. There is no automatic reinstatement at either the federal or state level.

Medicaid Transportation Call Center Changes

Effective October 1, 2014, Southeastrans Transportation Inc. will become the non-emergency medical transportation prior authorization contractor the Department of Health & Hospitals.

Clients may begin scheduling transportation for the month of October by calling 1-855-325-7565 beginning September 22, 2014. The Southeastrans Call Center is open from 6am-6pm Monday-Friday.

If a trip is already scheduled, clients may call �Where�s My Ride� at 1-855-325-7566 to inquire about the existing scheduled trip. They may also call this number to let the dispatcher know that an appointment is over and that they are ready to be picked up.

Transportation providers may contact Southeastrans at 1-855-325-7570 if they have any questions, comments, or concerns regarding the transporting of clients or issues regarding their transports, authorizations, and/or claims.

Medical facilities that have an inquiry or request for patient transportation may contact Southeastrans at 1-855-325-7576.

Southeastrans Contact Numbers

New Reservations (to schedule a trip)

855-325-7565    

Where's My Ride (to inquire about an existing trip )

855-325-7566    

NEMT Provider Line

855-325-7570    

Medical Provider Line

855-325-7576    

ATTENTION AMBULANCE PROVIDERS:

During the period March 2014 through June 2014, some hardcopy Ambulance Medicare Part B Crossover claims were incorrectly paid by Medicaid in error. Corrective action was taken to prevent further payment issues and affected claims are now being adjusted to correct the payments. It is possible for a single provider to have adjustments appear on multiple RAs until all claims have been adjusted. Any overpayments will be recovered from current provider payments.

The adjustment Internal Control Number (ICN) will carry a weekend julian date. The first round of adjustments will appear on the RA of September 23, 2014 with an ICN beginning with 4229. These claims will appear in the adjustment section of the RA, and adjustments will be done weekly until all claim corrections are completed. In cases involving multi-line claims, the entire original claim is rekeyed/adjusted for provider convenience and auditing purposes. Some adjusted claim lines will show no difference between the original payment and the adjusted payment. We apologize for any inconvenience this has caused providers.

ATTENTION LOUISIANA APPLIED BEHAVIOR ANALYSIS PROVIDERS

H2019/H2019HM are both to be used to provide one on one ABA services to Medicaid clients. Under the current constraints of the Medicaid ABA program group therapy is not to be provided.

If you have questions or concerns, please contact Rene' Huff at (225) 342-3935 or rene.huff@la.gov.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective October 1, 2014, based upon guidance from Centers for Medicare & Medicaid Services (CMS), pharmacy reimbursement methodology for Louisiana Medicaid Pharmacy Fee for Service (FFS) Program will change. Please refer to www.lamedicaid.com for specifics.

Attention Pharmacists and Prescribing Providers of Louisiana Medicaid Shared Plans and Legacy Medicaid:

Effective October 15, 2014, Pharmacy claims for recipients with Third Party Liability (TPL) must be submitted with the sales tax amount identified in the submission. Effective November 18, 2014, Pharmacy claims without this information submitted will deny with EOB 283, Sales Tax Not Present on Rx Claim with TPL. See lamedicaid.com.