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 Fee for Service (FFS) Louisiana Medicaid Providers:

Effective January 19, 2016 Fee for Service pharmacy claims will deny if the prescribing provider is not enrolled. Please refer to http://www.lamedicaid.com/provweb1/Pharmacy/Provider_memo_Prescribing_Providers_Enrollment_Denial.pdf for specifics.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective January 1, 2016 the La. Medicaid FFS Pharmacy Program will require clinical pre-authorization for prescriptions for the Hepatitis C Direct-Acting Antiviral Agents. Please refer to www.lamedicaid.com for specifics.

ATTENTION ALL PROVIDERS 2016 HCPCS UPDATE

Louisiana Medicaid is currently in the process of completing the 2016 HCPCS update. The Louisiana Medicaid files have been updated to reflect the deleted HCPCS codes for 2016. It is the Department's intent to have the new 2016 codes and updates on file as soon as possible including the appropriate editing and coverage determination for the new 2016 HCPCS codes.

Providers should submit claims for the appropriate HCPCS code to preserve timely filing. Claims denied due to the use of the new 2016 HCPCS codes not yet on file, will be recycled once the fee schedule updates are complete.

Most legacy Medicaid Fee Schedules on the Louisiana Medicaid website, www.lamedicaid.com, will be updated in the near future to reflect coverage of the new 2016 codes. Providers should monitor their RA messages for additional information.

New and Revised Place of Service Codes (POS) for Outpatient Hospital
Implementation Date 01-01-2016

The Centers for Medicare and Medicaid Services (CMS) made changes to the existing place of service code set by creating a new place of service (POS) code, code 19 (Off Campus-Outpatient Hospital), and revised the POS Code 22 (On Campus-Outpatient Hospital).

Louisiana Medicaid will accept POS 19 for any claims processed on or after January 1, 2016. That is, POS code 19 is valid for any claim, regardless of the date of service, when it is processed on or after January 1, 2016. The payment policies that currently apply to POS 22 will continue to apply to this POS, and will now also apply to POS 19.

CMS also issued minor corrections to POS codes 17 (Walk-in Retail Health Clinic) and 26 (Military Treatment Facility).

To access the CMS POS code set go to: https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html.

Should you have questions related to the place of service codes changes, please contact Molina Providers Relations at 1-800-473-2783. Questions regarding submission of claims to/payment by the correct entity should be directed to the MCO.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective January 12, 2016, Fee for Service pharmacy claims for Ombitasvir/paritaprevir/ritonavir (Technivie®) and Daclatasvir (Daklinza®) will have edits at Point of Sale (POS) similar to the other Hepatitis C direct acting antiviral agents. Please refer to www.lamedicaid.com for specifics.

Attention Durable Medical Equipment Prosthetics and Orthotics (DMEPOS) Providers 2016 HCPCS Update

HCPCS codes E0463 (Pressure Support Ventilator, Used with Invasive Interface) and E0464 (Pressure Support Ventilator, Used with Non-invasive Interface) will be removed from the Louisiana Medicaid DMEPOS fee schedule effective for date of service January 1, 2016. The codes have been discontinued by CMS.

Effective with date of service January 1, 2016, HCPCS code E0463 will be replaced with E0465 (Home Ventilator, Any Type, Used with Invasive Interface) and E0464 will be replaced with E0466 (Home Ventilator, Any Type, Used for Non-Invasive Interface). Reimbursement will be the same as the prior code.

The on-line fee schedule will be updated in the next few weeks. If you have questions regarding this matter contact Molina Provider Relation at 800-473-2783.

ATTENTION PROVIDERS WHO SUBMITTED ELECTRONIC FILES OF FEE FOR SERVICE PROFESSIONAL CLAIMS TO MOLINA ON THURSDAY, DECEMBER 31, 2015 WHICH DID NOT APPEAR ON THE 01/05/16 RA

We have learned that a systems issue occurred during the nightly processing cycle of December 31, 2015. Some claims files that were electronically transmitted on December 30, 2015 or December 31, 2015 were inadvertently not processed; therefore, they did not appear on the RA of January 5, 2016. These claims have been identified and are being processed on the RA of January 12, 2016. The pre-pay review edit 241 is being bypassed for paid claims so they will be paid on January 12, 2016 as expected. No action is required by providers and we apologize for any inconvenience this has caused.

If you have questions about the contents of this RA, you may contact Molina Provider Relations at 1-800-473-2783 or refer to www.lamedicaid.com.