RA Messages for December 14, 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
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.
NOTICE TO ALL
ENROLLED DIRECT SERVICE PROVIDERS
WITH THE FOLLOWING PROVIDER TYPES:
Adult Day Health Care
(ADHC), EDA Waiver Personal Assistance Services (PAS), Environmental
(HOME) Modifications (Environmental Accessibility Adaptations), Personal
Emergency Response System (PERS), and Long Term Personal Care Services (LTPCS)
It is the
responsibility of your agency to ensure the accuracy of the Freedom of
Choice Lists by updating and maintaining your agency information that is
presented to users via the Provider Locator Tool (PLT). Providers who
have not updated their additional contact information on the PLT by
January 1, 2011, will be removed from the Freedom of Choice list until
they do so. To view the Provider Locator Tool User Manual for
instructions on updating the additional contact information screen, go
to:
http://www.lmmis.com/provweb1/forms/userguides/ProviderLocatorInformationUserManual.pdf.
This option will only update the additional contactinformation on the
PLT and will not alter the information on the Provider Enrollment File.
If you want to update the Provider Enrollment File, go to:
http://www.lmmis.com/provweb1/Provider_Enrollment/ProviderEnrollmentIndex.htm.
ATTENTION ALL
PROVIDERS
IMPLEMENTATION OF DEC 1, 2010 RATE REDUCTIONS
Due to a funding
deficit in Medicaid caused by unfunded increases in utilization, the
Department of Health and Hospitals must implement a budget reduction
effective December 1, 2010. A portion of this reduction will come from
adjustments to current provider reimbursement rates ranging from 2-5.8%.
The state has published Emergency Rules which address these program
reductions which can be found online at the Office of State Register's
website at
http://www.doa.louisiana.gov/OSR/osr.htm by clicking on the
Emergency Rules tab on the left navigation bar of the homepage. Refer to
the homepage of the LA Medicaid website, www.lamedicaid.com, for a
summary of these rules and a link to the LA Register.
Providers will be notified when the new rates are loaded for each
program. At that time, providers should reference the LA Medicaid
website for the most current fees. Claims for dates of service after
December 1, 2010 that are adjudicated prior to the system update will be
systematically adjusted and no action is required by providers. Continue
to monitor future RAs. Contact the Provider Relations unit at (800)
473-2783 or (225) 924-5040 with questions related to the implementation
of the rate reductions and claim adjustments.
ATTENTION
LABORATORY, RADIOLOGY AND ASC (NON-HOSPITAL) PROVIDERS
IMPLEMENTATION OF DECEMBER 1, 2010 RATE REDUCTIONS
The reimbursement rate
reductions effective for dates of services on or after December 1, 2010,
for laboratory, radiology and ASC (Non-Hospital) have been loaded in the
system. Providers should reference the "Fee Schedules" link on the
homepage of the LA Medicaid website (www.lamedicaid.com) for the most
current fees. These rate reductions will begin appearing on the RA of
December 7, 2010. A systematic adjustment of claims will be unnecessary
due to timely implementation. Refer to the Office of the State
Register's website at
http://doa.louisiana.gov/osr/ for published rules detailing these
reductions.
ATTENTION
EARLYSTEPS PROVIDERS
IMPLEMENTATION OF DECEMBER 1, 2010 RATE REDUCTIONS
The reimbursement rate
reductions (two percent) effective for dates of services on or after
December 1, 2010, for certain EarlySteps direct services (OT, PT, ST,
Audiology & Psychology) provided in the natural environment have been
loaded in the system. Providers should reference the "Fee Schedules"
link on the homepage of the LA Medicaid website (www.lamedicaid.com) for
the most current fees. These rate reductions will begin appearing on the
RA of December 7, 2010. A systematic adjustment of claims will be
unnecessary due to timely implementation. Refer to the Office of the
State Register's website at
http://doa.louisiana.gov/osr/ for published rules detailing these
reductions.
ATTENTION HOME
HEALTH PROVIDERS
IMPLEMENTATION OF DECEMBER 1, 2010 RATE REDUCTIONS
The reimbursement rate
reductions (2%) effective for dates of services on or after December 1,
2010, for extended home health nursing services have been loaded in the
system. Providers should reference the "Fee Schedules" link on the
homepage of www.lamedicaid.com for the most current fees. These rate
reductions will begin appearing on the RA of 12/07/10. A systematic
adjustment of claims will be unnecessary due to timely implementation.
Refer to the Office of the State Register's website at
http://doa.louisiana.gov/osr/
for published rules detailing these reductions.
ATTENTION
PROVIDERS OF TAKE CHARGE FAMILY PLANNING WAIVER SERVICES
DIAGNOSIS CODE UPDATE
Effective with DOS
October 1, 2010, the 2010 ICD-9 diagnosis codes and operation codes have
been added to our files. The files have also been updated to deny those
codes now considered invalid. Providers should use the most complete and
appropriate diagnosis and operation codes when submitting claims to
Louisiana Medicaid.
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.
ATTENTION FREE
STANDING END STAGE RENAL DISEASE (ESRD) FACILITIES
IMPLEMENTATION OF DECEMBER 1, 2010 RATE REDUCTIONS
Effective with dates
of service on or after December 1, 2010, the reimbursement rates for
Free Standing ESRD Facilities are reduced by 2%, and these changes have
been loaded in the system. A systematic adjustment of claims will be
unnecessary due to timely implementation. Providers will begin seeing
these reductions on the RA of December 7, 2010. Refer to the Office of
the State Register's website at
http://doa.louisiana.gov/osr/ for published rules detailing these
reductions.
ATTENTION
PROFESSIONAL SERVICE PROVIDERS
IMPLEMENTATION OF OBSTETRICAL DELIVERY RATES
As part of the
initiative to reduce the number of premature births and reducing
preventable Cesarean deliveries, reimbursement for vaginal deliveries
has been increased to 90% of 2009 Medicare Region 99. The obstetrical
delivery rates effective for dates of services on or after December 1,
2010, Professional Service Providers have been loaded in the system.
Providers should reference the "Fee Schedules" link on the homepage of
the LA Medicaid website (www.lamedicaid.com)
for the most current fees. These rates will begin appearing on the RA of
December 7, 2010. A systematic adjustment of claims will be unnecessary
due to timely implementation. Refer to the Office of the State
Register's website at
http://doa.louisiana.gov/osr/ for published rules detailing these
reductions.
Louisiana Medicaid would like to remind OB/GYN providers that 17
Alpha-Hydroxyprogesterone Caproate (17P) was recently made reimbursable
for weekly intramuscular injections for use in pregnant women with a
history of pre-term delivery before 37 weeks and no symptoms of pre-term
labor in the current pregnancy. More information about 17P can be
located on the LA Medicaid website homepage (www.lamedicaid.com).
ATTENTION
HOSPITAL, PHYSICIAN AND OUTPATIENT RADIOLOGY PROVIDERS
New CPT codes become
effective January 1, 2011. These CPT codes will require prior
authorization (PA) and are included in the Radiology Utilization
Management (RUM) program. The codes are part of the diagnostic CT set
and are listed below:
- 74176 Computed
tomography; abdomen and pelvis; without contrast material
- 74177 Computed tomography; abdomen and pelvis; with contrast
material(s)
- 74178 Computed tomography; abdomen and pelvis; without contrast
material in one or both body regions, followed by contrast material(s)
and further sections in one or both body regions
If PA is not obtained
for these procedures per the current RUM guidelines, then the procedure
will not be payable by Louisiana Medicaid. For further information
regarding RUM policy and Procedure please visit
www.lamedicaid.com.
UPDATE FOR
PROVIDERS RECEIVING MEDICARE PART A CROSSOVER CLAIMS
DHH was notified by
Medicare on November 22nd that files electronically transmitted to
Medicaid contained an incorrect decimal placement on the claims
transmitted. Corrected claims have been re-transmitted to Medicaid for
processing. Because of this error, the original claims are being voided
on the RA of 12/21/10. The corrected claims will be processed and appear
on the RA of 12/28/10. Due to a delay in system processing, this
replaces the time-line reported on RA of 12/7/10. We apologize for any
inconvenience.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Contact
Molina Medicaid Solutions Provider Relations at (800) 473-2783 or (225)
924-5040 should you have any questions related to the implementation of
the rate reductions in any of the previous messages.