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 FREE-STANDING REHABILITATION CENTER PROVIDERS

Effective with dates of service on or after February 1, 2013, Rehabilitation Clinics (Provider Type 65) which are private/free-standing clinics will no longer receive reimbursement for rehabilitation services for Medicaid recipients age 21 and older.

This does not include rehabilitation services provided by hospital-based providers and home health agencies. This only applies to Providers Type 65 who provided services to recipients over 21.

In cases where Medicaid is the secondary coverage to private insurance, Medicaid shall no longer be billed for the recipient responsibility and therefore, the recipient may be billed for the co-payments. In instances where Medicare is the primary payer, Medicaid shall only be billed when the recipient is certified as a Qualified Medicare Beneficiary (QMB). Providers may bill all other Medicare recipients the co-insurance and deductible amounts.

There are no changes of any kind for Medicaid rehabilitation services for recipients under the age of 21.

ATTENTION PROFESSIONAL PROVIDERS PERFORMING BEHAVIORAL HEALTH SERVICES
FOR LEGACY OR SHARED HEALTH PLAN RECIPIENTS

With the March 1, 2012 implementation of the Louisiana Behavioral Health Partnership (LBHP), some claims submitted to Molina for payment were processed incorrectly and are being systematically reprocessed on this RA (2/11/13). These claims fall into one of the following categories:

  • Claims for behavioral health services performed in an emergency room setting that were paid in error and are being systematically voided on this RA:
    Providers receiving voided claims should resubmit these claims to Magellan/LBHP for consideration of payment.
  • Claims for basic behavioral health services in an outpatient setting that were denied in error with edit 555 and are now denying for the correct edit/reason code on this RA:
    Providers receiving denials with correct edit/reason codes should review these claims and resubmit correctly if a resubmission of the claim is appropriate.
  • Claims for basic behavioral health services in an outpatient setting that were denied in error with edit 555 and are now paying on this RA.

Please direct questions related to this recycling of claims to Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

Prescribing Providers and Pharmacists

As affirmed in the April 2012 issue of the Louisiana Board of Pharmacy quarterly newsletter, be advised that pharmacy-generated refill authorization documents that are received via fax from a prescriber represent a new prescription. As such, these prescription documents must be signed by the prescriber. They cannot be signed by the prescriber's agent.