RA Messages for November 2, 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 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.

ATTENTION FREE STANDING END STAGE RENAL DISEASE (ESRD) FACILITIES
IMPLEMENTATION OF AUGUST 1, 2010 RATE REDUCTIONS

Effective with dates of service on or after August 1, 2010, the reimbursement rates for Free Standing ESRD Facilities are reduced by 4.6%. Complex system changes initially resulted in delayed implementation of these reductions, but they have now been implemented. Providers will begin seeing these reductions on the RA of October 26, 2010. Refer to the Office of the State Register's website at http://doa.louisiana.gov/osr/ for published rules detailing these reductions. Claims that were adjudicated prior to October 20, 2010 are currently being assessed to determine an approach to systematic adjustment. No action is required by providers. Continue to monitor future RAs for details regarding when the recycle of these claims will take place. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the implementation of the rate reductions.

ATTENTION FREE STANDING END STAGE RENAL DISEASE (ESRD) FACILITIES
SYSTEMATIC ADJUSTMENT OF CLAIMS FOR JAN & AUG 2010 RATE REDUCTIONS

Providers will see adjustments to their weekly RA's on November 16, 2010, for claims with dates of service January 22, 2010-October 20, 2010 that were adjudicated prior to October 20, 2010. These claims will be systematically adjusted and no action is required by providers. Providers are encouraged to continue to monitor their RA's and the LA Medicaid website at www.lamedicaid.com for updates regarding the rate reductions. Please contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions concerning the rate reductions or adjustments.

ATTENTION COMMUNITYCARE PROVIDERS
COMMUNITYCARE ENHANCED FEES ENDING

Effective August 1, 2010, the CommunityCare enhanced reimbursement rates for select primary care services ended. CommunityCare providers will be reimbursed based on the applicable fee on Professional Services Fee Schedule. Refer to the Office of the State Register's website at http://doa.louisiana.gov/osr/ for published rules detailing these reductions. Providers should visit the LA Medicaid website, www.lamedicaid.com, for updates to the Professional Services Fee Schedule.

Providers will begin seeing adjustments to their weekly RAs for claims with dates of service August 1, 2010-September 21, 2010, that were adjudicated prior to September 21, 2010. These claims will be systematically adjusted and no action is required by providers. Should you have questions concerning this change, please contact Provider Relations at (800) 473-2783 or (225) 924-5040.

INFLUENZA IMMUNIZATION FOR ADULTS

Louisiana Medicaid reminds providers that seasonal influenza immunizations are a covered service for adults. Professional Services providers may be reimbursed for the seasonal influenza vaccine and the administration of the vaccine. For detailed information, see www.lamedicaid.com, following the link for Billing Information / Immunizations / Adult Immunizations Policy. For the current Immunization Fee Schedule, follow the link for Fee Schedules / Immunization Fee Schedules / Adult. Contact Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225) 924-5040 if you should have any questions.

ATTENTION PROVIDERS OF TAKE CHARGE FAMILY PLANNING WAIVER SERVICES

The TAKE CHARGE Program is limited to coverage of family planning services ONLY, and only those services are approved and payable. The approved list of diagnosis codes is available in the documentation for this program online at www.takecharge.dhh.louisiana.gov, and the family planning diagnosis MUST be the PRIMARY DIAGNOSIS on any claim for TAKE CHARGE recipients. This supports the fact that you are seeing the patient for family planning services and billing Medicaid for those services. Effective 11/09/2010 all TAKE CHARGE claims that do not include one of the approved codes, as the PRIMARY DIAGNOSIS code on a TAKE CHARGE claim, will DENY. If reporting other diagnoses on the claim is appropriate, they should be reported as additional diagnoses. Also, please remember, if services other than the covered family planning services are in order, the recipient should be informed prior to the visit/prior to providing the services that such services are not covered through the TAKE CHARGE Program.