RA Messages for
October 10, 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.
ATTENTION PROVIDERS
Good News for Louisiana
Medicaid Providers: We are pleased to announce that Louisiana Medicaid
will begin posting standard remittance advices (RAs) on the website,
www.lamedicaid.com, for provider
access. Over the years, providers have made this request and we are
happy to be able to comply with this request at this time. As we
transition to posting RAs online, we will stop printing and mailing
standard paper remittance advices to providers, billing agents, or other
entities representing providers. RAs will be posted weekly on the secure
side of the website. A new link, Weekly Remittance Advices, will be
available for accessing these documents in PDF format. Providers that
are not registered on our website must register in order to access the
secure side. Once registered, providers may grant logon access to
appropriate staff and/or any entity representing them. Individuals
allowed to access these RAs will have the ability to download and save
or print the documents for reconciling accounts.
A one (1) month grace period will occur from October
1, 2011, to November 1, 2011, during which RAs will be mailed and posted
on the website. This will allow providers ample time to implement
procedures for appropriate individuals to access this information
online. Effective November 1, 2011, standard RAs will be available only
online through the web site. Please visit our website for additional
information.
NOTE: This transition does not impact the HIPAA 835 electronic RA
procedures or process.
ATTENTION DURABLE
MEDICAL EQUIPMENT (DME) PROVIDERS OF
COCHLEAR IMPLANT AND SUPPLIES
Please note the following DME HCPCS codes which are
being discontinued on 10/31/2011, and the appropriate replacement codes
which are to be submitted for prior authorization (PA) requests dated
11/01/2011 forward. The PA requirements and medical necessity criteria
that were applicable for the discontinued codes apply for the
replacement codes.
Discontinued codes
Replacement codes
L8620
L8623
L8624
The payment amounts for the replacement codes are noted on the updated
fee schedule which can be found on:
www.lamedicaid.com.
ATTENTION HOSPITAL PROVIDERS
Effective with date of processing on or after
November 1, 2011, claims processing will be changed to reflect the use
of the new guidelines on Point of Origin (form locator 15) according to
the National Uniform Billing Committee (NUBC). This was formally called
Source of Admission. This change affects inpatient claims billed on the
electronic 837I claims and the paper claims on the UB 04.
Any questions should be directed to Provider Relations.
ATTENTION ALL PROVIDERS USING THE
ELECTRONIC CLAIMS STATUS INQUIRY (eCSI) WEB APPLICATION
Effective October 17, 2011, there will be several
changes for the users of the LA Medicaid Electronic Claims Status
Inquiry (eCSI) web application. These changes are the discontinuance of
returning certain recipient demographic information (Date of Birth and
Sex) and claims payment information (Payment Method and Medical Record
Number) on the response screen and inclusion of a link to the HIPAA/LA
MEDICAID ERROR CODE CROSSWALK report. The error code crosswalk report
ties together the HIPAA Claim Adjustment Reason code, the HIPAA Claim
Remark Code, and the LMMIS Proprietary Error Code. The Provider User
Manual attached within the eCSI web application and located on
lamedicaid.com, under the Forms/Files/User Manuals link, will be updated
to reflect these changes.