RA Messages for
October 26, 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 PHARMACY PROVIDERS
New this influenza season is the Fluzone�
intradermal vaccine, which is indicated for ages eighteen to sixty-four.
This vaccine is not provided by the Louisiana Vaccines for Children
(VFC) program this season. Therefore, Medicaid will reimburse pharmacy
providers the cost of the vaccine and its administration when given to
recipients who are ages eighteen through sixty-four.
Reimbursement by Medicaid of this influenza vaccine and
administration is limited to the following fees:
| Vaccine |
Maximum Vaccine Reimbursement |
Maximum Administration Fee Reimbursement |
| Influenza Vaccine, Intradermal |
$18.38 |
$15.22 |
Please click the link for Pharmacy & Prescribing Providers
link, and then the Influenza link, and see the 2011-2012 Influenza Season
section for detailed policy, reimbursement, and billing information.
ATTENTION PROVIDERS
Effective November 1, 2011,
Louisiana Medicaid will stop printing and mailing standard paper
remittance advices to providers, billing agents, or other entities
representing providers. Weekly standard paper remittance advices (RAs)
will be posted on the secure side of the Louisiana Medicaid website,
www.lamedicaid.com. 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 to 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
website. 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.
ATTENTION PROFESSIONAL SERVICES PROVIDERS
RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENTS
Louisiana Medicaid has recently made the following radiopharmaceutical
diagnostic imaging agents payable on the procedure code file effective
January 1, 2010:
- A9503 (Technetium Tc-99m, Medronate, diagnostic, per study dose, up
to 30 millicuries)
- A9507 (Indium IN-111 Capromab Pendetide, diagnostic,per study dose,
up to 10 millicuries)
- A9512 (Technetium Tc-99m-Pertechnetate, diagnostic, per millicurie)
- A9560 (Technetium Tc-99m Labeled Red Blood Cells, diagnostic, per
study dose, up to 30 millicuries)
- A9562 (Technetium Tc-99m Mertiatide, diagnostic, per study dose,
up to 15 millicuries)
- A9572 (Indium IN-111 Pentetreotide, diagnostic, per study dose,
up to 6 millicuries)
The system has been updated to reflect this change. Claims
for these
imaging agents with dates of service January 1, 2010, through April 6,
2011, that were adjudicated prior to April 7, 2011, were systematically
adjusted on October 12, 2011.
Effective with date of processing August 16, 2011, claims for
radiopharmaceutical diagnostic imaging agents will only be reimbursed
when billed with the appropriate medically necessary radiological
procedure. The imaging agent is not to be paid unless the appropriate
radiological procedure is also paid on the same date of service.
Providers are encouraged to contact the Provider Relations unit at
(800) 473-2783 or (225) 924-5040 with questions concerning this issue.
ATTENTION PROFESSIONAL SERVICES PROVIDERS
INFLUENZA IMMUNIZATIONS FOR ADULTS - NEW VACCINE AVAILABLE
A new influenza virus vaccine for intradermal use will be available for
the 2011-2012 influenza season. This vaccine is currently licensed and
indicated for use in patients 18 years through 64 years of age.
Louisiana Medicaid has added this new vaccine as a covered service for
recipients 18 through 64 years of age only. This intradermal influenza
vaccine will be in addition to the currently covered influenza,
pneumococcal and human papillomavirus vaccines. At this time, this
vaccine will not be available from the Louisiana Vaccines for Children
(VFC) program.
Professional Services providers may be reimbursed for
seasonal influenza
vaccines and the administration of the vaccines for adult recipients. As
the new intradermal vaccine will not be available from the VFC program
for the 2011-2012 season, Louisiana Medicaid will reimburse providers
for the new intradermal influenza vaccine as well as for the
administration of the vaccine for recipients aged 18 through 64 years.
If at a later date this vaccine does get included in the VFC program,
Louisiana Medicaid will no longer reimburse providers for the vaccine
for recipients 18 years of age but only for the administration of the
vaccine.
For detailed information, see www.lamedicaid.com, following the link for
Billing Information/Immunizations/Adult Immunization Policy. For the
current Immunization Fee Schedule, follow the link for Fee
Schedules/Immunization Fee Schedules and choose the Immunization
Fee Schedule appropriate for the recipient's age.
Contact Molina Medicaid Solutions Provider Relations at (800)
473-2783
or (225) 924-5040 if you should have any questions.
ATTENTION PROFESSIONAL SERVICE PROVIDERS
The Department is pleased to inform providers, effective November 1,
2011, the list of diagnosis codes reimbursable for Hyperbaric Oxygen
Therapy has been updated. The diagnosis codes for the following
conditions will now be reimbursable as follows:
Acute carbon monoxide intoxication,
Acute peripheral arterial insufficiency,
Acute traumatic peripheral ischemia,
Chronic refractory osteomyelitis unresponsive to conventional
treatment,
Crush injuries and suturing of severed limbs,
Decompression illness,
Diabetic wounds of the lower extremities,
Gas embolism,
Gas gangrene,
Osteoradionecrosis as an adjunct to conventional treatment,
Preparation and preservation of compromised skin grafts,
Progressive necrotizing infections,
Soft tissue radionecrosis as an adjunct to conventional treatment.
Providers should contact the Provider Relations unit at (800) 473-2783
or (225) 924-5040 with billing or policy questions.