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.

Urgent National Correct Coding Initiative Update: Preventive Care Codes and Immunization Administration Codes

As stated in the October 2013 web notification: Effective 2014, states will no longer have CMS approval to deactivate the preventive care and immunization administration code pairs; for that reason, Louisiana Medicaid fee for service (legacy) and Bayou Health Plans must reactive these edits. CMS has provided the following guidance which shall allow both the immunization administration and the preventive medicine evaluation and management (E/M) service to be reimbursed.

"If a Medicaid beneficiary receives one or more immunizations and a "significant, separately identifiable" preventive-medicine evaluation and management (E/M) service from the same provider on the same date of service, the provider's Medicaid claim(s) should include both the immunization administration code . . . and the comprehensive preventive-medicine E/M code . . . with modifier 25 appended . . . .

If the provider . . . bills a comprehensive preventive-medicine E/M code for the same day and does not append modifier 25, the Medicaid PTP edits will deny payment of the preventive medicine E/M code."

Louisiana Medicaid fee for service (legacy) and Bayou Health Plans will reimburse both the immunization administration and the preventive medicine E/M services when modifier -25 is properly appended to the preventive medicine E/M procedure code. Documentation in the clinical record must substantiate each service.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 of (225) 924-5040.

ATTENTION ALL PROVIDERS: PROCESSING ERROR IMPACTED CLAIMS ON 01/21/14 RA

An error occurred during the weekly claims processing cycle last week which had the following impact on claims processed on your 01/21/14 RA:

  • Adjustments or voids on the 1/21/14 remittance may have incorrectly denied with Error Code 799.
  • Claims may have paid inappropriately because most duplicate edits and service limit edits did not apply due to the error.

Impacted original claims, adjustments and voids have been identified and will be recycled and appear on the RA of 01/28/14. The inappropriately paid claims and their replacement will have the first four digits of the ICN as 4019.

We apologize for any inconvenience that this error has caused.