RA Messages for November 10, 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.  

Detailed FUL changes eff. 11/28/08 are posted on www.lamedicaid.com. 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. 

PREFERRED DRUG LIST CHANGES/CORRECTIONS

Ciclopirox Suspension and Tolcapone (Tasmar) were listed incorrectly on the Preferred Drug List (PDL) effective November 1, 2008. The correct status is:

Ciclopirox Suspension - Preferred
Tolcapone (Tasmar) - Requires PA

Please reflect the noted changes on your copy of the PDL mailed October 20.

COVERAGE OF IMMUNIZATIONS FOR ADULT RECIPIENTS

Effective with date of service October 1, 2007, LA Medicaid reimburses professional service providers for select CPT procedure codes specific to immunizations for influenza, pneumococcal, and human papillomavirus diseases for adult recipients ages 21 and older. The necessary logic changes are complete to allow these services to be paid. Claims that have been held may now be submitted. Providers that have claims that were not initially submitted and are now over the timely filing limit must coordinate submission of the claims with Unisys Provider Relations at (800) 473-2783. A systematic claims recycle of all denied claims will occur in the near future and providers will be notified of the details in upcoming RA messages. A detailed provider notice and a fee schedule of vaccine codes covered by LA Medicaid are located on the LA Medicaid web site, www.lamedicaid.com, links New Medicaid Information and Fee Schedules, respectively.

ATTENTION PHARMACY PROVIDERS

Updates to the Pharmacy Benefits Management Services Manual are now available on the Louisiana Medicaid web site at www.lamedicaid.com. Pharmacy providers should refer to the manual for a complete description of Medicaid pharmacy program policy.

ATTENTION DENTAL PROVIDERS

Dental policy changes in regards to the EPSDT Dental codes D9230, D9248, and D9920 went into effect on October 7, 2008. Complete details are placed on the www.lamedicaid.com web site under the "New Medicaid Information" and "Billing Information" links. If you have questions, you may contact the LSU Dental Medicaid Unit at 504-941-8206 or 1-866-263-6534 (toll-free).

ATTENTION PHYSICIANS/CLINICS

As a result of Hurricane Gustav we implemented logic to bypass various edits, including some service limit edits, for dates of service August 27th through September 30th. One of those edits, Edit 907 (Physician/Clinic Visits Exceeded) was not bypassed correctly for the affected dates of service. Claims that were denied because of this have been identified and will be recycled for correct payment in the 11/04/08 RA. No action is required by providers.

ATTENTION HOSPITAL PROVIDERS

You were notified in the 2007 Louisiana Medicaid Hospital Provider Training packet that only 1 revenue code 450 or 459 may be used per emergency room visit. Providers have continued to inappropriately bill multiple revenue codes 450 and 459. As a result, programming logic has been implemented recently to deny claims billed with these multiple codes. One revenue code 450 or 459 (as appropriate) should be billed and should be accompanied by the correct, appropriate procedure code 99281-99285. Other procedure/HCPCS codes are inappropriate. Providers billing multiple codes 450 and 459 are now receiving denial edit 114 (invalid/ missing HCPCS) for lines displaying procedure codes other than 99281-99285, and denial edit 093 (revenue code missing/invalid) for the claim line displaying the correct procedure codes 99281-99285. The 093 denial code is being changed to reflect new denial code 113 (only 1 ER revenue 450-459 code per visit). It is necessary for any provider billing multiple ER revenue codes and receiving these details to resubmit the single, correct revenue code line with the correct procedure/HCPCS code for consideration of payment. Please discontinue this practice immediately!

NOTICE TO PROVIDERS OF HOSPICE SERVICES

Policy Clarification
- Revocations must be submitted to the Hospice Program within 3 working days of the revocation. Any revocation submitted after the 3 day limit will become effective on the date of receipt.
- The effective date of receipt will not be changed once it is entered into the system due to billing time frames of various entities.
- The patient's or the authorized representative's signature is required whenever a patient revokes hospice. The patient must sign the form at  the time of the revocation only and not at the time of the hospice election. Revocations cannot be back dated.
- The revised Hospice Notice of Election form can be accessed at www.lamedicaid.com. Providers are no longer allowed to alter/revise this form.
- A legal representative who signs a Notice of Election form must indicate the relationship to the patient with a daytime telephone number. All legal representatives must sign and date the form. Hospice providers cannot date or predate the forms.

ATTENTION ALL PROVIDERS

Effective with dates of service October 1, 2008, forward, the 2009 ICD-9 Disease and Procedure Classification Code Updates have been added to our files. Claims that have denied for invalid diagnosis/procedure codes prior to the loading of the 2009 ICD-9 data will be recycled and no action is required by the provider. Providers will be informed via RA message when the recycle will take place.

ATTENTION PROVIDERS BILLING TPL CLAIMS

Effective with date of processing November 10, 2008, the logic changes for processing TPL claims for Home Health, LTC, ADHC, and Dental providers are now in place and effective for all TPL claims. These providers may also begin submitting TPL claims electronically. Logic changes for the Rehabilitation Center 102 paper claim form are also effective for this processing date. Changes for EDI claims submitted by Rehabilitation Centers and other providers submitting EDI claims with the 837P were effective in March of this year. Additionally, TPL claims claims paid using the new logic can now be adjusted - either electronically or hard copy. Updates will soon be made to the EDI Companion Guides as appropriate. TPL changes for ambulance transportation claims will be forthcoming. Please watch future RAs for this transition. Questions concerning these changes may be addressed to Unisys Provider Relations at (800) 473-2783 for general questions or the Unisys EDI Help Desk at (225) 216-6303 for technical questions concerning EDI billing.

ATTENTION KIDMED PROVIDERS

Effective with date of processing Monday, December 1, 2008, the KIDMED Claims Processing Subsystem will be merged into the Medicaid Claims Processing System which processes all other Medicaid claims. This merge will be beneficial for KIDMED providers and should remove many of the current problem areas related to processing KIDMED claims through a separate subsystem prior to the claims data entering the regular Medicaid subsytem for processing. Current KIDMED claims reports will also be revised or eliminated. Detailed provider notices concerning this transition are being posted on the Home page and the New Medicaid Information link of the LA Medicaid web site, www.lamedicaid.com. Please visit the web site to obtain the details of this important transition that will affect you. After reviewing these notices, any questions may be directed appropriately to Unisys Provider Relations at (800) 473-2783, the Unisys EDI Helpdesk at (225) 216-6303, or the Unisys Web Technical Support Team at (877) 598-8753.