RA Messages for October 14, 2008

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 PHARMACISTS AND PRESCRIBING PROVIDERS

The drug categories that were reviewed at the August 13, 2008 P&T meeting will be implemented into the PDL/PA process on November 1, 2008.

PHARMACY PROVIDERS, PLEASE NOTE

LMACs have been removed from products which are now provided by a single manufacturer unless a Federal Upper Limit is in place. Providers should refer to APPENDIX A found at www.lamedicaid.com. The effective date of these changes is October 15, 2008. Please file adjustments for claims that may have been incorrectly paid.

ATTENTION TAKE CHARGE FAMILY PLANNING WAIVER- ANESTHESIA PROVIDERS

Several months ago, it was brought to our attention that Anesthesia Providers rendering services to Take Charge participants were paid incorrectly for procedure code 00851 (anesthesia for Tubal Ligation/ Transection). Necessary changes were made to pay this procedure code correctly for claims paid for dates of processing 04/29/08 and after. Incorrectly paid claims for dates of processing on or before 04/28/08 are being recycled on the 09/30/08 RA.

ATTENTION HOSPICE, HEMODIALYSIS AND HOSPITAL PROVIDERS

We have learned that a system problem occurred on outpatient claims processed in the checkwrites dated 09/02/08 and 09/09/08. This problem caused the Units and Billed Charge fields on these claims to be expanded by one digit, and the claims were priced and paid accordingly. We have corrected this error and will process systematic adjustments for the erroneously processed claims. No action is required on your part. The majority of these claims were overpaid which necessitates a recoupment from the provider. A few of the claims will be systematically adjusted to correct the incorrect Units or Billed charges only, and there will be no adjustment/ difference in the Medicaid paid amount for these claims. The systematic adjustments will be displayed in the Adjustment Claims/ Previously Paid Claims sections of your remittance advice dated 09/30/08. We apologize for any inconvenience this error may have caused. Contact Unisys Provider Relations at (800) 473-2783 or (225) 924-5040 if you have questions.

ATTENTION ALL PROVIDERS

Effective for dates of service October 1, 2008, forward, claims processing edits that were lifted as a result of Hurricane Gustav as posted on the web site, www.lamedicaid.com, will be reinstated. All providers should begin following normal procedures for servicing and billing for LA Medicaid recipients. CommunityCARE/KIDMED auto-assignments will resume with linkages for October 2008. Emergency provider enrollment procedures will be rescended at that time, also. Questions regarding these procedures may be directed to Unisys Provider Relations at (800) 473-2783 or (225) 924-5040.

INTRODUCING HMS PROVIDER PORTAL

HMS, DHH's TPL contractor, has developed an automated application (Provider Portal) for providers to use in conjunction with recoupment projects (i.e., commercial insurance and Medicare projects). The application has also been customized to notify providers of claims paid by carriers to DHH as a result of HMS billings so that providers can submit claims directly to insurance carriers in accordance with Act 517 of the 2008 Louisiana Statutes. Each provider must contact HMS to enroll in the Provider Portal.

Please contact Ms. Amy Parks of HMS at 214-453-3132 or via email at aparks@hms.com to complete your enrollment application. We hope you will take advantage of this automated system. Thank you.

PEDIATRIC MODERATE (CONSCIOUS) SEDATION:
CURRENT CPT CODES 99148, 99149 and 99150

Effective January 1, 2008, Louisiana Medicaid will reimburse for moderate sedation services provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports. Providers are responsible for adherence to the updated "Pediatric Moderate (Conscious) Sedation" policy, which is located at www.lamedicaid.com under "New Information," and will be published in an upcoming "Louisiana Medicaid Provider Update."

ATTENTION HOSPITAL PROVIDERS

System changes have been made to correct editing associated with primary and add-on codes for screening mammograms. Louisiana Medicaid policy allows payment of one screening mammogram per calendar year for females at least 40 years of age. The screening mammogram may consist of one primary procedure and one add-on procedure, each billed with HR403. For date of service January 1, 2007, and forward, allowable HCPC codes are 77057 (primary) and 77052 (add-on). For dates of service in 2006, allowable codes are 76092 (primary) and 76083 (add-on). Programming is now in place to allow these codes to pay correctly. A recycle of claims for dates of service January 1, 2006 - August 2, 2008, was recently completed and appeared on the September 30, 2008, remittance advice.