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 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.

Update to 'ClaimCheck' Product Editing - February 2014

McKesson's 'ClaimCheck' product is routinely updated by the McKesson Corporation based on quarterly and annual changes made to the resources used, such as Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), provider specialty society updates, the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule Database, and/or the National Correct Coding Initiative (NCCI).

The most recent updates to the 'ClaimCheck' product are pending finalization, but are expected in the next few weeks. Once implemented, providers can expect that most claims will continue to be edited in the same manner; but when applicable, claims may now pay or deny for a different reason.

For questions related to this information as it pertains to legacy Medicaid or Bayou Health Shared Savings Plans, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

Attention Take Charge Program Providers - Take Charge Reimbursement Rate Change

It has been brought to our attention that several procedure codes payable under the Take Charge Waiver did not pay at the correct reimbursement rate. Claims submitted after January 6, 2014 should pay at the correct rate. Claims submitted prior to January 6, 2014 will be recycled to correct the payment amount. We will send another RA message to notify providers of the date this recycle will occur. The Fee Schedule for Take Charge Waiver is available on the Louisiana Medicaid Website, www.lamedicaid.com.

ATTENTION PROVIDERS: ACA-Eligible Claims Recycle for Newly Attested Providers

On November 7, 2013, DHH notified providers of their decision to extend the deadline to submit a Medicaid Primary Care Services Designated Physician form and be eligible for enhanced reimbursement retrospective to January 1, 2013. Pursuant to this notification, providers who submitted a correct and complete Designated Physician form to Molina Provider Enrollment by December 31, 2013 will have their claims with dates of service in 2013 recycled in order to receive the correct payment. Only claims paid under legacy Medicaid or Bayou Health Shared Savings plans (Community Health Solutions of America and United Healthcare Community Plan) will be affected. The claims were recycled in the January 28,2014 check write.

This recycle should only affect providers who did not meet the previous deadline of June 28, 2013 but whose Designated Physician form was processed prior to 2014. For more information on the enhanced reimbursement, see the "ATTENTION PRIMARY CARE PROVIDERS: Affordable Care Act Primary Care Services Enhanced Reimbursement Information" (11/18/13) bulletin posted on www.lamedicaid.com.

Attention Pharmacists:

Effective February 20, 2014, prescriptions written for iloperidone (Fanapt®) will have a maximum daily dosage limit of 24 mg/day. Claims which exceed the maximum daily dosage limit will deny through Point of Sale (POS). See www.lamedicaid.com for more information.