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

Revisions have been made to the on-line Medicaid Recipient Insurance Information Update form found in lamedicaid.com. A drop-down box was added to the TO: field listing all 5 Bayou Health plan's names, fax and phone numbers, as well as DHH's fax and phone number. Providers should select and fax the form to the correct Bayou Health plan for each Medicaid recipient. If the recipient is still in traditional Medicaid (no plan), the form should be faxed to DHH. This will assure that the appropriate persons are receiving the forms and completing the updates in a timely manner. The previous form is now obsolete so this form should no longer be submitted. Please use revised form only. See instructions below to locate form in lamedicaid.com.

Click on Forms/Files/User Manuals on the left navigational bar. Then, click on Online Forms. Scroll down to Medicaid Recipient Insurance Information Update Form - Private Insurance Plans and Medicare Advantage Plans. Fill in form, print and fax to the plan or DHH.

If you have questions, please call Jackie Porta @ 225-342-9463 or Danny Murnane @ 225-342-4902. Thank you for your cooperation in this matter.

Bayou Health Administrative Corrections for Retroactive Enrollment and Retroactive Disenrollment Monthly Process

DHH identified paid claims associated with administrative corrections of member?s linkages into Bayou Health Plans. These linkage corrections were necessary to ensure compliance with internal policies, approved Medicaid State Plan and maintaining audit controls.

Beginning March 17, 2015, the process of voiding identified paid claims by an incorrect entity (Shared Plans: CHS & UHC, and Legacy Medicaid) will be repeated on a monthly basis to occur mid-month for administrative corrections made to member linkages in the prior month. Molina will void all identified paid claims with a denial reason code 999 Administrative Correction which is shown on the Remittance Advice.

In order to rebill, providers must verify the correct entity based on the date of service by using either MEVS or REVS. To obtain consideration for payment, providers are required to submit claims to the correct entity no later than 6 months from the date the claim is voided. If PA or Pre-Cert was obtained on the original claim, providers will not be required to obtain additional authorization when submitting these specific prior-paid claims to the correct entity. Documentation must accompany claims verifying the void.

This documentation of prior payment will also support the authorization of the service. Claims submitted within 6 months of the void date will not be denied based on timely filing.

NOTE: Pharmacy claims should not be resubmitted through the Molina POS. All Pharmacy claims should be submitted using the NCPDP universal claim form accompanied by documentation verifying the void.

For more information, please visit www.makingmedicaidbetter.com or lamedicaid.com "Attention All Providers: Bayou Health Administrative Corrections for Retroactive Enrollment and Retroactive Disenrollment-Monthly void process will begin March 17, 2015".

Questions may be sent to Bayou Health at bayouhealth@la.gov, with the subject lined addressed to "Retro Claims".