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 www.lamedicaid.com. 

TO ALL LOUISIANA PHARMACIES

Regarding the previous notice of January 27, 2012 relative   to a public records request for pharmacy data related to the Survey of   the Average Cost of Filling a Medicaid Prescription in the State of    Louisiana: As of today, a determination has been made that the Louisiana Department of Health and Hospitals, including its agents and contractors, will not release any of the requested pharmacy data in response to the request. This notice is being provided via email to the pharmacy stake- holder representatives listed below and supersedes the above referenced notice of January 27, 2012.

Stakeholders:

Doug Robichaux - doug@healthcare-pharm.com
Bernard LeBas - lebasb@legis.state.la.us
Allan Hansen - ahansen@mslc.com
Fred Mills - mills@legis.state.la.us, fred@fmbanking.com
James Shin - jshin@mslc.com
Kris Knerr - Kknerr@mslc.com
Kevin McCarter - Kevin.mccarter0@wal-mart.com
Linda Spradley - linda@spradleyandspradley.com
Phyllis Perron - pperron@pperron.com
Sonya Hall - shall@mslc.com
Mary Staples - mstaples@NACDS.org
Bud Courson - bud@coursonnickel.com
Randall Johnson - johnson@lipanow.org

ATTENTION PROFESSIONAL, DME, HOSPITAL, AND HEMODIALYSIS PROVIDERS
THAT MUST BILL CLAIMS USING NATIONAL DRUG CODES (NDC)

Effective with the remittance advice (RA) dated 01/18/12, the LA Medicaid Online RA has been changed to include the National Drug Code (NDC) when it is submitted on a claim from the provider. This information will appear immediately below the procedure description on the affected RA claim line. This change does NOT affect the online RAs for pharmacy providers submitting drug claims through POS. The positioning of the NDC data for these RAs/claims will remain the same. This change also does NOT affect NDC data returned through the 835 electronic remittance advice. The return of the NDC data for 835s will remain the same.

ATTENTION ALL PRESCRIBING PROVIDERS

 The Request for Prescription Prior Authorization fax form (Rx PA01) has been updated to enable Providers to indicate the Prescribing Provider by inputting either their LA Medicaid Provider Number or NPI Number when filling out this form. For more information, please refer to the revised RXPA instructions available at www.lamedicaid.com.

ATTENTION PRIMARY CARE PROVIDERS (PCPs)

Have you enrolled with a BAYOU HEALTH Plan yet? If not, starting with dates of service 2/1/12, you will no longer receive reimbursement for providing services to Louisiana Medicaid recipients who reside in the New Orleans or Northshore Regions (Orleans, Jefferson, St. Bernard, Plaquemines, St. Tammany, Washington, St. Helena, Livingston, and Tangipahoa Parishes) and are enrolled in a BAYOU HEALTH Plan unless you have contracted with, or made other arrangements with the BAYOU HEALTH Plan the recipient is linked to on the date of service. For further information, visit the website at www.makingmedicaidbetter.com or participate in daily phone calls with DHH being held Monday through Friday (from noon - 1:00 p.m.) by calling 1-800-278-0296, pass-code 7299088.

VERIFYING HEALTH PLAN & ELIGIBILITY INFORMATION FOR BAYOU HEALTH MEMBERS

Beginning 2/1/12, REVS, MEVS, and E-MEVS applications will show the name of the BAYOU HEALTH Plan and their phone number for Medicaid recipients enrolled in BAYOU HEALTH. Enrollment in a BAYOU HEALTH Plan is for the entire calendar month. This information will be located where current CommuniyCARE PCP information is, and will no longer contain the PCP name. You may obtain PCP information from the BAYOU HEALTH Plan. DHH is making revisions that will allow future month Health Plan and eligibility information to be shown in these applications. Further information will be forthcoming.

ATTENTION DENTAL PROVIDERS: LaCHIP AFFORDABLE

                                 PLAN ADDS DENTAL                             

Effective February 1, 2012, dental benefits wills be available to recipients in the LaCHIP Affordable Plan (LAP). There are approximately 3,600 children in LAP as of December 2011. LAP is a separate state program and different from regular LaChip (Louisiana Children's Health Insurance Program). LAP recipients receive  benefits through the Louisiana Office of Group Benefits (OGB) Preferred Provider Organization (PPO). OGB administers only major medical and prescription benefits and claims processing for this cost-sharing  program.

Louisiana Medicaid, not OGB, will be administering the dental benefits  and claims processing for these LAP recipients. The recipients will receive a letter informing them of their dental coverage. They will not be receiving a Louisiana Medicaid card. Please note: their PPO medical card and/or OGB ID number should not be used to file dental claims on these recipients.

To inquire about a child's dental benefits, providers should verify  eligibility using the eMEVS system at http://www.lamedicaid.com and  choose the feature to search by SSN and DOB. For additional identifying information on a member, providers should call the LaCHIP Hotline at 1-888-342-6207.

ATTENTION COMMUNITY CARE PROVIDERS

Current CommunityCARE Primary Care Providers (PCPs), that intend to continue rendering care to Louisiana Medicaid recipients as PCPs in the BAYOU HEALTH program, must ensure that each Health Plan is provided with the 7-digit Medicaid legacy provider ID and corresponding NPI enrolled   in CommunityCARE. PCPs with CommunityCARE linkages at more than one  location must also include the appropriate 3-digit site number for each enrolled location. This information is available on the CommunityCARE   CP-0-92 reports submitted for payment of the monthly management fees.  

NOTE: Physician group practices, FQHCs, and RHCs must also provide the Medicaid Ids and NPIs for the individual practitioners at each CommunityCARE-enrolled location.

 For assistance verifying the enrolled Medicaid legacy provider ID, PCPs may also contact the CommunityCARE contractor at 1-800-259-4444, option #3.

      ATTENTION LOUISIANA MEDICAID PROVIDERS

Effective for dates of service on or after 2/1/2012, claims for Medicaid State Plan Services provided to BAYOU HEALTH Plan members, must be submitted to the Health Plan the member is linked to. If they are billed directly to Molina, the claims will deny, advising you to submit the claim to the Health Plan. Claims for carved out services not covered  under BAYOU HEALTH Plans, will continue to be billed to Molina. For further information, visit the website at www.makingmedicaidbetter.com.

Click on the Providers link, and review the list of carved out services located on the ' Medicaid Provider Billing Changes for Dates of Service Beginning February 1, 2012' document.

ATTENTION LOUISIANA MEDICAID PROVIDERS

The CommunityCARE and KIDMED programs are ending statewide with the implementation of BAYOU HEALTH. As BAYOU HEALTH phases into a Geographic Service Area (GSA), CommunityCARE and KIDMED linkages for enrollees residing in the GSA will terminate.

There will be no new CommunityCARE or KIDMED provider enrollment applications processed. Provision of EPSDT screening services for KIDMED enrollees transitioning into BAYOU HEALTH will be the responsibility of the individual Health Plans.

Existing PCPs are notified of the procedure for ensuring uninterrupted medical care for transitioning CommunityCARE/KIDMED enrollees as BAYOU HEALTH implementation begins in the GSA. Notices for GSAs A and B may be viewed at www.la-communitycare.com, www.makingmedicaidbetter.com,or www.lamedicaid.com.