RA Messages for October 19, 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 OF INFLUENZA VACCINE

The 2010-2011 seasonal influenza vaccine includes as one of its three components the same H1N1 vaccine used for the 2009-2010 H1N1 pandemic. Also, as of 09/16/2010, the only remaining available 2009-2010 monovalent H1N1 vaccine inventory in circulation reached its expiration and should no longer be used. Therefore, effective 09/16/2010, procedure code 90663 (influenza virus vaccine, pandemic formulation) will be in non-payable status and claims submitted with dates of service 09/16/2010 and after will deny. Providers submitting claims for the 2010-2011 seasonal influenza vaccine should use the appropriate CPT procedure code for the vaccine formulation administered following current immunization billing policy. Detailed information on the 2010-2011 seasonal influenza vaccine can be found at www.cdc.gov/flu. Contact Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225) 924-5040 if you should have any questions.

DIAGNOSIS CODE UPDATE

Effective with DOS October 1, 2010, the 2010 ICD-9 diagnosis codes and operation codes have been added to our files. The files have also been updated to deny those codes now considered invalid. Providers should use the most complete and appropriate diagnosis and operation codes when submitting claims to Louisiana Medicaid.

ATTENTION MENTAL HEALTH CLINIC (MHC) PROVIDERS

As of 09/16/2010, the only remaining available 2009-2010 monovalent H1N1 vaccine inventory in circulation reached its expiration and should no longer be used. Effective 09/29/2010, procedure code 90663 (Influenza virus vaccine, pandemic formulation) will be in non-payable status and claims submitted with dates of service 09/16/2010 and after will deny. Contact Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225) 924-5040 if you should have any questions.

ATTENTION ALL DME PROVIDERS - INCLUDING PHARMACIES
PROVIDING DME SERVICES

Effective November 5, 2010, Louisiana Medicaid will require DME providers to submit National Drug Code (NDC) information on prior authorization requests and claims submissions for enteral therapy products dispensed to Medicaid recipients. This requirement applies to all DME providers, including pharmacies that dispense the DME supplies to Medicaid recipients. NDC information must be submitted on PA requests received on November 5, 2010 forward and associated claims in order to prevent denial of services. Please visit the LA Medicaid website homepage at www.lamedicaid.com for details, including the list of products and associated NDC data and other important information.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
UPDATE REGARDING CLAIM ADJUSTMENTS ON THE 9/22/10 & 10/16/10 RAs

The remaining claim adjustments for the Aug 4, 2009 and Jan 22, 2010 rate reductions were completed on either the RA of Sept 22, 2010 or Oct 6, 2010. Refer to the notices on the homepage of the Louisiana Medicaid website (www.lamedicaid.com) for details regarding the rate reductions and claim adjustments.

Providers affected by the Oct 5, 2010 RA payment/recovery error were repaid the amount recovered in error beginning on Mon, Oct 11, 2010. In an effort to ensure that no further errors occur for providers having funds recovered through their weekly RAs, DHH will not be deducting funds from the RA of October 19 and potentially not from the RA of Oct 26, 2010. This action is being taken in an effort to ensure adequate testing of the system is completed prior to re-establishing these payment plans. Continue to monitor RAs and the LA Medicaid website. The Department will, however, recover funds for any provider that has requested that their full negative balance be recovered in one RA beginning on the October 19, 2010 RA.

Any provider still interested in an alternative payment plan is STRONGLY ENCOURAGED to send an email by OCTOBER 26, 2010 to medicaidprofessionalservices@la.gov detailing your request. Please enter "Alternative Payment Plan" in the subject line. This request is being made to help minimize any future errors due to the sporadic influx of requests the Department is receiving.

CLAIMCHECK: RECYCLE OF MODIFIER -51 DENIALS

The recycle of claims that have been previously denied for errors related to modifier -51 (934 and 938) is scheduled to appear on the remittance advice of October 19, 2010. 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. The small number of claims that must pend for either medical review and/or issues such as timely filing will be handled outside of this recycle. Please continue to monitor the Louisiana Medicaid website homepage at www.lamedicaid.com, under the ClaimCheck icon on the website, as well as future 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.