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: Eligible Providers
Are you a Medicaid provider with a Certified EHR system? If so, it’s NOT too late to receive up to $63,750!! The deadline to attest to AIU and MU has been extended to March 31, 2017! Current and new Medicaid Providers who have purchased an EHR by December 31, 2016 are eligible. For more information on the Medicaid EHR Incentive program, email us at: ehrincentives@la.gov or Call a Medicaid EHR Specialist at 225-342-4810 or 225-342-7742.
Attention Louisiana Medicaid Providers:
Effective Februmy 14, 2017. Fee-for-Service (FFS) Medicaid will have Point of Sale (POS) edits for cariprazine (Vraylar®) pharmacy claims.
Please refer to www.lamedicaid.com for more information.
Attention Louisiana Medicaid Providers:
Effective Februmy 14, 2017. Fee-for-Service (FFS) Medicaid updated the ICD-10-CM diagnosis code requirements for adalimumab (Humira®) and abobotulinumtoxinA (Dysport®) pharmacy claims.
Please refer to www.lamedicaid.com for more information.
Attention Louisiana Medicaid Providers:
Effective Februmy 14, 2017. Fee-for-Service (FFS) pharmacy claims for perampanel
(Fycompa®) will have Point of Sale (POS) edits and FFS pharmacy claims for
sacubitril/valsartan (Entresto®) will require clinical pre-authorization.
Please refer to www.lamedicaid.com for more information.
ATTENTION PROVIDERS:
POLICY CLARIFICATION: Every provider is held responsible on the federal and state level for ensuring that their employees have not been excluded.
To determine if an employee or prospective employee is excluded on the state level, check the Louisiana Department of Health’s Adverse Actions website at the link below:
https://adverseactions.dhh.la.gov/
*Please note: The website should be checked upon hire and monthly thereafter.
This is a state database containing all individuals and providers who are excluded. You can search by name and verify with a Social Security Number (SSN) if you have one. Providers are required to maintain printed confirmation of the checks from the website as verification of compliance with this mandate. If the exclusion is learned prior to employment the provider should not employ the person or entity. If the provider learns of the exclusion after hiring the employee, the provider must notify the Louisiana Department of Health within 10 working days of discovering the exclusion. If you have any questions or comments or need to report an issue with an excluded worker or entity, please contact the Program Integrity Section via email at DHH.Medicaid.State.Exclusions@LA.gov.
ATTENTION PROVIDERS:
POLICY CLARIFICATION: Every provider is held responsible on the federal and state level for ensuring that their employees have not been excluded.
To determine if an employee or prospective employee is excluded on the state level, check the Louisiana Department of Health’s Adverse Actions website at the link below:
https://adverseactions.dhh.la.gov/
*Please note: The website should be checked upon hire and monthly thereafter.
This is a state database containing all individuals and providers who are excluded. You can search by name and verify with a Social Security Number (SSN) if you have one. Providers are required to maintain printed confirmation of the checks from the website as verification of compliance with this mandate. If the exclusion is learned prior to employment the provider should not employ the person or entity. If the provider learns of the exclusion after hiring the employee, the provider must notify the Louisiana Department of Health within 10 working days of discovering the exclusion. If you have any questions or comments or need to report an issue with an excluded worker or entity, please contact the Program Integrity Section via email at DHH.Medicaid.State.Exclusions@LA.gov.
There are additional mandatory checks that should be done – refer to your policy manuals, public health L.A.C. rules, remittance advice messages and provider updates for more information on the following websites: CNA-DSW State Registry, Office of Inspector General Office (OIG) national database, System for Award Management (SAM) national database.