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. 

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.