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 PROFESSIONAL SERVICES PROVIDERS:

It has been brought to the Department's attention that code J1050, Medroxyprogesterone Acetate was inadvertently added to the Medicaid procedure file in 2013 without the appropriate budgetary reduction to the fee. This reimbursement amount has been corrected and the Professional Services Fee Schedule has been updated. All impacted claims will be recycled for potential recoupment and/or adjustments of funds on the RA of February 25, 2014. No action is required by providers.

For questions related to this recycle, please contact Molina Medicaid Provider Services at (800) 473-2783 or (225) 924-5040.

TO ALL DME PROVIDERS

Effective March 1, 2014, all prior authorization requests for standing frames should be submitted using the standing frame criteria and form. This criterion has been updated in the DME provider manual and the standing frame form is labeled Appendix G. All standing frame requests submitted without the standing frame form will be denied.

Attention Pharmacists and Prescribing Providers

On the RA of January 28th some pharmacy claims were voided by providers through POS. On the RA of February 4th, these same claims were systematically voided again in error. We have generated manual pharmacy claims to offset the erroneous duplicate voids and these claims will appear on the March 4th RA. The ICN range of these manual claims is 4054888800001 to 4054888812908. We apologize for any inconvenience this may have caused pharmacy providers.

Attention Pharmacists and Prescribing Providers:

Diagnosis codes will be required on pharmacy claims for select specialty drugs. Please refer to the website for the complete list with appropriate diagnosis codes. These new edits will be effective March 12, 2014. See www.lamedicaid.com.