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 ALL PROVIDERS - 2017 HCPCS UPDATE

Louisiana Medicaid is currently in the process of completing the 2017 Healthcare Common Procedure Coding System (HCPCS) update. Part of the update includes changing Louisiana Medicaid files to reflect the deleted HCPCS codes for 2017. It is the Department's intent to have the new 2017 codes and updates on file as soon as possible including the appropriate editing and coverage determination for the new 2017 HCPCS codes.

Providers should submit claims for the appropriate HCPCS code to preserve timely filing. Claims denied due to the use of the new 2017 HCPCS codes not on file as of January 1, 2017, will be recycled once the fee schedule updates are complete.

Applicable Fee Schedules on the Louisiana Medicaid website, www.lamedicaid.com, will be updated in the near future to reflect coverage of the new 2017 codes. Providers should monitor their RA messages for additional information.

Please contact the appropriate Managed Care Organization with any questions concerning their 2017 HCPCS updates. For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Professional Providers, Independent Laboratory Providers, Take Charge Plus Providers and Outpatient Hospital Providers

Effective with dates of service January 1, 2017 and forward, Louisiana Medicaid will no longer reimburse for routine cervical cancer screening for recipients under the age of 21 years.

However, Medicaid considers cervical cancer screening medically necessary for recipients under age 21who have the following conditions/diagnosis.

  • Recipients who were exposed to diethylstilbestrol before birth
  • Human immunodeficiency virus (HIV)
  • A weakened immune system
  • History of cervical cancer
  • Other criteria subsequently published by ACOG.

  • It is the responsibility of the treating provider to provide hard copy supporting documentation needed for billing purposes to the laboratory provider upon testing.

  • Providers of these laboratory services must submit hard copy supporting documentation to the fiscal intermediary to have the age restriction bypassed for a specific clinical situation.

  • Claims filed with hard copy supporting documentation to the fiscal intermediary will pend to Medical Review for confirmation of the conditions that are considered medically necessary.

  • If the hard copy documentation is not present, the claim for the test will be denied.

  • If the hard copy supporting documentation is present and meets the clinical criteria, the pend and age edits will be overridden and the claim will be released and processed as normal.