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 LOUISIANA MEDICAID PROVIDERS

Providers who participated in the CommunityCARE program were previously advised that effective with dates of service June 1, 2010, the Department would no longer pay PCP management fees (procedure code CC001) for linked enrollees after the month of the enrollee's death. Based on Audit findings, it was determined that some deceased enrollees remained active in CommunityCARE in error. Although CommunityCARE terminated statewide as of June 1, 2012, management fees inappropriately paid to PCPs after the month of an enrollee's death will be automatically calculated and recouped. These recoupments will be identified on the Remittance Advice with error edit 364 - RECIPIENT DECEASED.

NOTICE TO ALL PHYSICIAN PROVIDERS

The Office of Population Affairs (OPA) has updated the Sterilization consent form. The new form is available on their website at http://www.hhs.gov/opa/order-publications/#pub_sterilization-pubs. You may also download a fillable PDF version from the Louisiana Medicaid Website at http://www.lamedicaid.com/provweb1/Forms/Sterilization_Consent.pdf. Providers should begin utilizing the current form effective immediately; however, the form with the expiration date effective 12/31/2012 will be authorized by the Department as an acceptable consent until April 1, 2013. Beginning with dates of service April 1, 2013 and beyond, Health Plans and Molina will only accept the Consent form with the expiration date of October 31, 2015.

Molina shall only accept the Consent form with the expiration date of October 31, 2015, beginning with dates of Service April 1, 2013. Please visit http://www.lamedicaid.com/ for the notice. If you have any questions please contact Molina Provider Relations (800)473-2783 or (225)924-5040.

Attention Physicians and Hospital Providers: Effective 1/1/2013
Changes to PA requirements for RUM

Effective January 1, 2013, prior authorization for high-end Radiology services for Legacy or Fee for Service Medicaid recipients will no longer be required. Providers should only order services that are medically necessary. Please visit http://www.lamedicaid.com/. for the notice. If you have any questions please contact Molina Provider Relations (800)473-2783 or (225)924-5040.