RA Messages for November 12, 2013
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 http://www.lamedicaid.com/.
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
ATTENTION PCS PROVIDERS
CLAIMS DENIED IN ERROR DUE TO PREPARATION FOR CHANGES IN SERVICE LIMITS
In preparation for service limit changes for LT-PCS, logic was altered prior to notifying providers of these
changes. Starting with the RA of 10/8/13, claims processed for LT-PCS services for T1019 UB, T1019 UN, and
T1019 UP with daily units greater than 32 and less than 47 denied with edit 542 (units exceed maximum daily
allowed limit). This logic change is being reversed to put the educational edit 543 (units paid between 33
and 47) back in place temporarily and denied claims are being recycled. No action is required by providers.
Please monitor RA messages and the web site for additional upcoming information concerning these service limit
changes.
For questions related to this notification, please contact Molina Medicaid Solutions Provider Services at (800)
473-2783 or (225) 924-5040.
Revised status on LTC/ICF-DD Adjustments and Voids scheduled for the 10/29/2013 checkwrite
Molina generated adjustments and voids originally scheduled for processing for the October 29, 2013
have been re-scheduled for processing on the November 5th, 2013 checkwrite. Please be aware that this
in no way delays or defers the processing of provider-submitted adjustments/voids on payments. For
questions or concerns regarding this notification, please contact Molina Medicaid Solutions Provider
Services at (800) 473-2783 or (225) 924-5040.
NCCI Changes to Preventive Care/Immunization Administration Billing Effective January 2014
Effective January 2014, there are changes to CMS's National Correct Coding Initiative
(NCCI) billing guidance: Providers are directed to the Louisiana Medicaid homepage,
(www.lamedicaid.com/) for details on new CMS directives
when billing for preventive care and immunization administration codes on the same date of service.
ATTENTION PROVIDERS: DEADLINE EXTENSION FOR AFFORDABLE CARE ACT ENHANCED REIMBURSEMENT
DHH has extended the deadline to submit a Medicaid Primary Care Services Designated Physician form and
receive an effective date for enhanced reimbursement retrospective to January 1, 2013. In previous
guidance, the deadline was June 28, 2013. The final deadline is now December 31, 2013. If your
complete and correct form is received after December 31, 2013, you will receive enhanced reimbursement
for eligible services rendered on or after the date the form is received.
For more information on the enhanced reimbursement, see the "ATTENTION PRIMARY CARE PROVIDERS:
Affordable Care Act Enhanced Reimbursement of Primary Care Services Informational Bulletin" posted
on www.lamedicaid.com.