RA Messages for December 1, 2011

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 PHARMACY PROVIDERS

The deadline for being compliant with NCPDP D.0 is fast approaching. Please be sure that any software changes needed for interface with your telecommunications switch vendor are complete and will be ready for use no later than January 01, 2010. If you have any questions or concerns about readiness for submitting claims using the new transaction, be sure and contact your software vendor and your telecommunications switch vendor as soon as possible. These vendors provider pharmacies with the ability to test electronic claims for compliance with D.0 transaction standards. Visit lamedicaid.com for additional information on NCPDP D.0 implementation using the 5010v of the the HIPAA Electronic Transactions 11/7/11 link. Specifications for Medicaid vendor point of sale (POS) adjudication, as well the appendices, are available on the website.

ATTENTION PROFESSIONAL SERVICE PROVIDERS
ANESTHESIA POLICY

Louisiana Medicaid has received multiple inquiries related to the denied reimbursement of claims specific to Pain Management. Louisiana Medicaid Pain Management policy states:

"Epidurals administered for the prevention or control of acute pain, such as that which occurs during delivery or surgery, are covered by the Professional Services Program for this purpose only. Epidurals given to alleviate chronic, intractable pain are not covered."

Therefore, epidurals or nerve block anesthesia administered to a recipient following a surgical related procedure for the prevention on management of postoperative pain will not be reimbursed.

UPDATE AND CLARIFICATION OF OBSTETRICAL SERVICES AND
POSTPARTUM CARE POLICY

It has come to the attention of DHH that some providers are continuing to submit claims for CPT code 59430 (Postpartum care only [separate procedure]) when they have also submitted and been paid for one of the delivery codes that include postpartum care. It has been the intent of DHH that when the delivery codes that include postpartum care were made payable, separate reimbursement for postpartum care was no longer valid if those inclusive codes were used. Providers who perform both the OB delivery services and the postpartum care should use the code that describes these services and not unbundle the services by use of individual procedure codes. As with all claim submissions, providers are to use the most inclusive code available. Only when there is not a more appropriate code available should providers use the separate code for the postpartum service. At no time does Louisiana Medicaid intend to reimburse more than once for postpartum care. Providers should refer to the Current Procedural Terminology manual for additional coding guidance related to these services. Providers are urged to review their billing practices and take action as needed to be in compliance with Medicaid policy. Overpayments and abusive billing are subject to recoupment and/or sanction.

FAMILY PLANNING WAIVER "TAKE CHARGE" PROVIDERS

Procedure codes 76830 - Echography Transvaginal, 76856 - Echography Pelvic, Real Time, and 85025 - Blood Count; Plat. Count Auto/Amt. are not currently covered by the Louisiana Medicaid Take Charge family planning waiver program. Providers are responsible for knowing if a service is not covered and should inform the recipient prior to rendering the service.

ATTENTION PROFESSIONAL SERVICES PROVIDERS
CONCURRENT CARE CLAIMS RECEIVING DUPLICATE EDITS

Due to a system error some claims for inpatient Concurrent Care were erroneously denied as duplicate claims. The logic that allowed the posting of this edit in error has been corrected and all claims impacted by this edit problem have been identified and will by systematically adjusted on 12/1/11. Some of the recycled claims will pend or deny for other, correct edits. Providers must review and resubmit any denied claims that can be corrected and resubmitted for processing. Please contact Provider Relations at (800) 473-2783 or (225) 924-5040 with questions concerning this issue.