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.

Attention Professional Services Providers:
ACA Requirement to Enter Ordering Provider on Medicaid Claims

Effective for claims with dates of services on or after April 1, 2017, the NPI of the ordering provider must be entered in the appropriate location on Professional claims submitted to Louisiana Medicaid, and that provider must be enrolled with Louisiana Medicaid. Claim records where the ordering provider NPI is missing; is inaccurate; is not enrolled; or is not on file as of the date of service will deny. If a referring provider NPI is submitted on a claim, they also must be enrolled with Louisiana Medicaid or the claim will deny.

The NPI of the billing provider and the ordering provider may not be the same NPI, except in cases where an independently practicing professional provider (physician, APRN, optometrist, podiatrist, etc.) is the billing provider and the ordering provider.

Claims editing related to the above changes will be reflected as educational on RA’s prior to the April 1, 2017 implementation date.

Questions regarding this message and fee for service claims should be directed to Molina Provider Relations at (800) 473-2783 or (225) 924-5040.

Updates to Healthy Louisiana related systems and claims processing changes are plan specific and are the responsibility of each health plan. For questions regarding Healthy Louisiana updates, please contact the appropriate health plan.

2017 Assistant Surgeon and Assistant at Surgery Covered Procedures

Louisiana Medicaid has published the 2017 fee-for-service list of allowed procedures for assistant surgeons and assistant at surgery providers. The list titled, "2017 Assistant Surgeon and Assistant at Surgery List of Covered Procedure Codes" has been posted to the LA Medicaid website (www.lamedicaid.com) under the ClaimCheck icon.

The changes are based on updates made by the McKesson Corporation to their ‘ClaimCheck’ product. McKesson uses the American College of Surgeons (ACS) as its primary source for determining assistant surgery designations.

This list does not ensure payment but provides a comprehensive list of codes that may be allowed when billed by an assistant surgeon or by an assistant at surgery.

Please contact the appropriate Managed Care Organization with any questions concerning their updates. For questions related to this information as it pertains to fee-for-service Medicaid claims processing, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.