RA Messages for November 23, 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 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 PROVIDERS

For Medicaid pharmacy services beginning December 1, 2010, the Department of Health and Hospitals, Bureau of Health Services Financing will establish a four-prescription limit per recipient per calendar month. Please refer to www.lamedicaid.com for detailed information.

ATTENTION ALL PROVIDERS OF EPSDT PERSONAL CARE SERVICES

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Personal Care Services (PCS) program has revised the EPSDT-PCS Form 90 to include the physician's order. Effective January 1, 2011, all EPSDT-PCS prior authorization requests must be submitted using the EPSDT-PCS Form 90 with revision date November 1, 2010. Molina's Prior Authorization Unit will continue to accept requests on the current form until December 31, 2010; however, all requests received on or after January 1, 2011 that do not include the revised EPSDT-PCS Form 90 will be denied. Therefore, providers should begin using the revised form immediately when developing requests.

Molina's Prior Authorization Unit will continue to accept the form 90-L along with a physician's order for Children's Choice waiver recipients in lieu of the EPSDT-PCS Form 90 as long as the form 90-L was completed by the recipient's doctor within 90 days of the current EPSDT-PCS request.

A copy of the revised EPSDT-PCS Form 90 is available on the website at www.lamedicaid.com, following the Forms/Files/User Guides link.

ATTENTION HOSPITAL PROVIDERS: UPDATE TO RETROSPECTIVE REVIEW PROCESS

The process for submitting a request for precertification of retrospective reviews for acute inpatient hospitals was revised on October 18, 2010. After further review and after considering feedback from providers, the process has been updated. The revised process and procedure for requesting retrospective precertification for acute inpatient hospitals can be located on the Louisiana Medicaid website. These updated changes are effective November 29, 2010.

Please visit www.lamedicaid.com for detailed provider notices concerning these changes.