RA Messages for November 9, 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 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.

ATTENTION ALL PROVIDERS

Effective immediately, electronic signatures from prescribing providers for all Prior Authorization and Pre Certification requests will be accepted. Such Prior Authorization or Pre Certification requests will not be denied if the signature from the prescribing provider is in electronic format rather than an original signature. This also applies to any other type of provider that may be required to sign a document for Prior Authorization or Pre Certification. For purposes of Prior Authorization and Pre Certification, an electronic signature is a computer generated signature with the computer generated statement, "signature on file," and/or a copy of the physician's actual signature electronically appended thereto.

ATTENTION HOSPITAL PROVIDERS
IMPORTANT BILLING INFORMATION CONCERNING
BILLING CLAIMS FOR DELIVERIES

As we have implemented new policies related to inpatient stays for deliveries, we have received hospital inquiries concerning claim denials related to diagnosis codes. We want to clarify a billing issue that has come to our attention which is causing these denials.

Please visit www.lamedicaid.com for the detailed provider notice explaining what information must be present in order for the claim to process.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
UPDATE REGARDING 9/22 & 10/16/10 CLAIMS ADJUSTMENTS:
PAYMENT PLANS TO RESUME

Providers affected by the Oct 5, 2010 RA payment/recovery error have been repaid the amount recovered in error. In an effort to ensure adequate testing of the system prior to re-establishing the payment plans, DHH has temporarily ceased deducting funds from the weekly RAs of October 19-November 9, 2010. All programming and testing is now complete and recovery of funds will resume on the RA of November 16, 2010 & spread over the number of weeks remaining in the payment plans.

Refer to the notices on the homepage of the Louisiana Medicaid website (www.lamedicaid.com) for details regarding the rate reductions & claim adjustments. General questions with regard to rate reductions & claim adjustments should be directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040. Any questions specific to individual providers' alternate payment plans or recovery of funds should be referred to the Medicaid Professional Services office at medicaidprofessionalservices@la.gov. Please enter either of these topics in the subject line.

ATTENTION EDI SUBMITTERS

The 2011 EDI Annual Certification forms have been mailed. The form is also located on www.lamedicaid.com, under the EDI Information link. Please complete and return the 2011 Annual Certification form to the Molina EDI Department by December 31, 2010, to avoid closure of your submitter number, which will result in your file being dropped without being processed.