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 Gainwell Technologies at (800) 473-2783 or (225) 924-5040.

For information regarding the medication policy and/or criteria associated with this denial, providers may access the Louisiana Medicaid Preferred Drug List (PDL) / Non-Preferred Drug List at http://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf.

Attention Local Education Agency (LEA) Providers

Federal regulations require states to screen and enroll all Medicaid providers that order, prescribe, or refer items or services for Medicaid beneficiaries. Participating LEAs should expect claim denials on interim claims submitted for reimbursement if ordering provider enrollment requirements are not complete by December 30, 2023. To fulfill requirements, physicians and non-physician practitioners whose order results in health care services being provided by an LEA must enroll as a fully participating fee-for-service provider or an Ordering, Prescribing, Referring (OPR) provider type. The ordering provider’s name, their Type 1 (individual) NPI and DK qualifier must be on all claims,with exception of nursing evaluations and preventative screenings. The ordering provider may be an individual physician or other licensed practitioner associated with the student’s plan of care or may be the actual provider performing the service if they have licensing authority within their defined scope of practice to order health care services. LEA employees and contracted practitioners currently enrolled as participating LA Medicaid fee-for-service providers are not required to enroll separately as an OPR provider. Please refer to the home page of www.lamedicaid.com to review policy notice: ‘School-Based Provider Enrollment Requirements’ for additional details. Providers who are unsure of their fee-for-service enrollment status or require enrollment assistance should contact Gainwell Technologies at 225-216-6370 or email louisianaprovenroll@gainwelltechnologies.com.

2023 Annual 1099 Notice for Providers

Louisiana Medicaid 2023 1099’s will be distributed by U.S. Mail on or before January 31, 2024. Electronic copies are now available for download by going to the Louisiana Medicaid website, www.lamedicaid.com, Secure Portal, application link, Online 1099. If replacement copies or additional copies are needed, providers must print them from the website. If you feel there is an error on your 1099, please contact Gainwell Provider Enrollment at 225-216-6370. Prior year 1099’s will be stored in the archive on www.lamedicaid.com.